Cavernous sinus thrombosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Cavernous sinus thrombosis (CST) is a thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic condition.
In the pre-antibiotic era, infections of the middle third of the face were responsible for the majority of cases. Currently, acute sinusitis is the most common predisposing condition.
Diagnosis is usually made through clinical evaluation together with imaging (computed tomography or magnetic resonance imaging).
In the acute presentation, one eye is typically affected first, followed by the second eye within 48 hours of symptom onset.
Must be differentiated from meningitis. Common early clinical features of both conditions include fever, headache, vomiting, and nuchal rigidity.

Patient with bilateral cavernous sinus thrombosis. Note the bilateral proptosis, which is more marked in the right eye

Vidhate MR, et al. Bilateral cavernous sinus syndrome and bilateral cerebral infarcts: a rare combination after wasp sting. J Neurol Sci. 2011;301:104-106. Used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Anatomy of the cavernous sinus: (1) third ventricle, (2) pituitary gland, (3) oculomotor nerve, (4) trochlear nerve, (5) internal carotid artery, (6) abducens nerve, (7) ophthalmic branch of the trigeminal nerve, and (8) maxillary branch of the trigeminal nerve
Proptosis of the right eye in a patient with cavernous sinus thrombosis secondary to dental infection
Patient with bilateral cavernous sinus thrombosis. Note the bilateral proptosis, which is more marked in the right eye
Ocular manifestations of cavernous sinus thrombosis and their underlying pathology
Sagittal CT scan of the head demonstrating an enlarged, tubular right superior ophthalmic vein
Postcontrast venous phase CT scan of the head (axial view) showing an enlarged 'S'-shaped right superior ophthalmic vein with associated proptosis
Treatment of aseptic cavernous sinus thrombosis (CST)
Treatment of septic cavernous sinus thrombosis (CST)

Citations

Key Articles

Ebright JR, Pace MT, Niazi AF. Septic thrombosis of the cavernous sinuses. Arch Intern Med. 2001 Dec 10-24;161(22):2671-6.[Abstract][Full Text]
Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: A review. Surv Ophthalmol. 2021 Nov-Dec;66(6):1021-30.[Abstract]
Bhatia K, Jones NS. Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature. J Laryngol Otol. 2002 Sep;116(9):667-76.[Abstract]
American College of Radiology. ACR appropriateness criteria: headache. 2022 [internet publication]. [Full Text]
American College of Radiology. ACR appropriateness criteria: orbits, vision, and visual loss. 2017 [internet publication].[Full Text]

Referenced Articles

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