HWN Suggests

Preceptal /Orbital Cellulitis & Cavernous Sinus Thrombosis

Clinical presentation is due to the venous obstruction as well as impairment of the cranial nerves that are run through/along the cavernous sinus

• Headache is the most common symptom and usually precedes fevers, periorbital edema, and cranial nerve signs
• Periorbital edema and chemosis result from occlusion of the ophthalmic veins
• Lateral gaze palsy (isolated cranial nerve VI) is usually seen first since CN VI lies freely within the cavernous sinus, in contrast to CN III and IV, which lie within the lateral walls of the sinus
• Ptosis, mydriasis, and eye muscle weakness from cranial nerve III dysfunction
• Manifestations of increased retrobulbar…

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  Cavernous Sinus Thrombosis – Diagnosis and Treatment

The next patient you pick up presents with “Eye Problem” per the triage note. The triage vitals are notable for a temp of 101.5F. You go to see the patient and find a miserable looking middle-aged male with a painful red eye. He tells you that he’s had nasal congestion for weeks and has been fishing for juicy boogers with a new “As Seen on TV” product.

 Atypical Cavernous Sinus Thrombosis: A Diagnosis Challenge and Dilemma

Cavernous sinus syndrome is an ocular emergency. Progression is usually fast with devastating effects and can be life threatening. Majority of cavernous sinus thrombosis (CST) arises from trauma and paranasal sinus infections attributing to Staphylococcus aureus infection. Due to the anatomical configuration, an intracranial extension is common with a high mortality rate.

 Cavernous Sinus Syndrome: Clinical Features and Differential Diagnosis with MR Imaging Read More: https://www.ajronline.org/doi/full/10.2214/ajr.181.2.1810583

Cavernous sinus syndrome can be caused by various disease entities. Understanding the characteristic clinical features and their implications as well as the characteristic imaging findings will assist in the differential diagnosis focused on this small but complex structure, the cavernous sinus.

 Differences between CVST and CST

Today let’s talk about cavernous sinus thrombosis (CST), or the infected subset of cerebral venous sinus thrombosis.

 Management

If CST is suspected, imaging should be ordered. Either computed tomography (CT) or magnetic resonance imaging (MRI) may be obtained, but CT tends to be the initial test of choice, as it is better than MRI in detecting thrombus directly in the cavernous sinus

Articles of Interest

Cavernous Sinus Thrombosis

Aseptic causes are less common than septic causes. These include trauma, surgery, or pregnancy. Because of the rarity of diagnosis, no randomized controlled trials are available, and expert opinion guides treatment. In general, antimicrobial and antithrombotic therapies are primary considerations.

Cavernous Sinus Thrombosis in Children

Cavernous sinus thrombosis (CST) is a rare and life-threatening complication of infection involving the paranasal sinuses, facial, and oral cavities. The incidence has likely decreased significantly because of the use of antibiotics. CST has been reported to cause CAN and vasospasm, embolic infarcts, and large territory infarction from hypoperfusion.

Cavernous Sinus Thrombosis in ENT Practice

The clinical presentation is usually due to the venous obstruction as well as impairment of the cranial nerves that are near the cavernous sinus. Headache is the most common presenting symptom. T

Cavernous sinus thrombosis: linking a swollen red eye and headache

A previously healthy 75-year-old woman presented in November, 2012, with a 10 day history of progressive headache, fatigue, and fever, and gradual onset periorbital oedema and reddish chemosis of the left eye. On examination she was alert and oriented without obvious neurological abnormalities. She had normal visual acuity and light reflex bilaterally. Eye movement was restricted on upward gaze of the left eye due to the oedema but was otherwise normal

Challenging presentations of cavernous sinus thrombophlebitis

We present two cases of CST with markedly differing clinical presentations, medical comorbidities, and degree of impairment. Initial imaging of each patient failed to show thromboembolic disease.

Clinical Anatomy of Cavernous Sinus Thrombosis

The cavernous sinus is complex, making it a difficult region for dental students to conceptualize and physicians to diagnose. This animation clarifies the spatial relationships between the cavernous sinus and its contents, demonstrates common routes of infection, and explains the common signs and symptoms associated with cavernous sinus thrombosis.

Septic Cavernous Sinus Thrombosis Caused by Sinusitis

Early signs and symptoms of cavernous sinus thrombosis are nonspecific, and they usually mimic primary headache syndromes. Headaches are the most common early sign, followed by fever, proptosis, chemosis, altered mental status, and cranial nerve III and VI palsies. Brain MRI is the most sensitive and specific imaging modality for cavernous sinus thrombosis, but head CT scan and lumbar puncture are useful...

Septic Thrombosis of the Cavernous Sinuses

Septic thrombosis of the cavernous sinuses (or cavernous sinus thrombophlebitis [CST]) is a dramatic and potentially lethal illness, which is still occasionally seen by clinicians. Before the availability of antimicrobial agents, mortality from CST was near 100%, but it markedly decreased to approximately 20% to 30% during the antibiotic era.1

Resources

Pediatric EM Morsels

Imaging: [Smith, 2015; Frank, 2015] Contrast-enhanced CT Useful, but has radiation concerns. Contrast-enhanced MRI [Rodriguez-Homs, 2019; Frank, 2015] More difficult to come by in the ED. Not MRV. MRV (venogram) has been found to miss some cases. The slow turbulent flow may allow thrombus to be missed on MRV.

JAMA Network

Septic thrombosis of the cavernous sinuses (or cavernous sinus thrombophlebitis [CST]) is a dramatic and potentially lethal illness, which is still occasionally seen by clinicians. Before the availability of antimicrobial agents, mortality from CST was near 100%, but it markedly decreased to approximately 20% to 30% during the antibiotic era. Nevertheless, the threat of death and serious morbidity continues to necessitate early recognition, diagnosis, and treatment of CST to minimize risks to the patient.

My Travel

Cavernous sinus thrombosis (CST) is usually a late complication of an infection of the central face or paranasal sinuses. Other causes include bacteremia, trauma, and infections of the ear or maxillary teeth. CST is generally a fulminant process with high rates of morbidity and mortality.

NHS

The cavernous sinuses are hollow spaces located under the brain, behind each eye socket. A major blood vessel called the jugular vein carries blood through the cavernous sinuses away from the brain.

Revista Brasileira de Oftalmologia

Cavernous sinus thrombosis (CST) is a rare condition, usually results from a late complication of an infection of the paranasal sinuses. Other causes include prothrombotic disorders, anemia and trauma. The signs and symptoms are extremely varied and nonspecific, being the diagnosis made through magnetic resonance imaging (MRI).

StatPearls

Cavernous sinus thrombosis (CST) is a rare, life-threatening disorder that can complicate facial infection, sinusitis, orbital cellulitis, pharyngitis, or otitis or following traumatic injury or surgery, especially in the setting of a thrombophilic disorder.

Teach Me Anatomy

The cavernous sinus is a paired dural venous sinus located within the cranial cavity. It is divided by septa into small ‘caves’ – from which it gets its name. Each cavernous sinus has a close anatomical relationship with several key structures in the head, and is arguably the most clinically important venous sinus.

Warning Signs Of Cavernous Sinus Thrombosis

This extremely rare condition can be life-threatening, so it is important to be aware of the symptoms in order to get the necessary treatment as soon as possible.

WikiEM

MRI with MR Venogram - study of choice CT head/orbits with IV contrast...CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT