Cavernous sinus thrombosis: Difference between revisions

 
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==Background==
==Background==
[[File:Gray571.png|thumb|Oblique section through the cavernous sinus.]]
*Severe infection involving complications of paranasal sinus and facial infections (e.g. manipulated midface abscesses, furuncles)  
*Severe infection involving complications of paranasal sinus and facial infections (e.g. manipulated midface abscesses, furuncles)  
*Frequent extension of thrombosis to opposite sinus  
*Frequent extension of thrombosis to opposite sinus  

Latest revision as of 19:59, 7 December 2022

The cavernous sinus is one of the several cerebral veins and cavernous sinus thrombosis is a specific type of cerebral venous (sinus) thrombosis. See that article for a discussion of the larger clinical entity.

Background

Oblique section through the cavernous sinus.
  • Severe infection involving complications of paranasal sinus and facial infections (e.g. manipulated midface abscesses, furuncles)
  • Frequent extension of thrombosis to opposite sinus
  • Low frequency, but high rate of morbidity/mortality
  • Structures within the Cavernous Sinus
    • V1 and V2
    • III, IV, VI
    • Internal Carotid Artery

Causes

Clinical Features

  • Fevers/chills
  • Nausea/vomiting
  • Headache
  • Eye exam
    • infraorbital/periorbital cellulitis
    • Exophthalmos (uni or bilateral)
    • Decreased vision
    • Absent pupillary reflexes
    • Decreased EOM secondary to CN III, IV, VI
    • Decreased corneal sensation secondary to CN V
  • If infection spreads into CNS: altered mental status, lethargy, meningeal signs

Differential Diagnosis

Evaluation

  • MRI with MR Venogram - study of choice
  • CT head Venogram acceptable choice if no MR available with 95% sensitivity [2]
    • CT findings can be subtle and if clinical suspicion is high cannot rule out with a negative CT
  • Blood cultures

Management

  • IV antibiotics:
  • Consider heparin if rapidly decompensating and CT negative for intracranial hemorrhage
  • Consider steroids to decrease inflammation in conjunction with antibiotics
  • Surgical drainage of primary infection if possible

Disposition

  • Consult ophthalmology, neurology, ID, and ENT (or other appropriate surgery subspecialty)
  • Admit to ICU

Complications

See Also

References

  1. Harris FS and Rhoton, Jr. AL. Anatomy of the cavernous sinus: A microsurgical study. Journal of Neurosurgery. 1976; 45: 169-180.
  2. Chiewvit P, Piyapittayanan S, Poungvarin N. Cerebral venous thrombosis: diagnosis dilemma. Neurol Int. 2011 Nov 29;3(3):e13. doi: 10.4081/ni.2011.e13. Epub 2011 Dec 15. PMID: 22368772; PMCID: PMC3286153.