In summary, cavernous sinus thrombosis is still with us. Although the advent of antibiotics has decreased the incidence of the condition, a clinician should be able to recognize its signs and immediately refer the patient to the proper specialists. Cavernous sinus thrombosis is usually secondary to paranasal sinus infection, orbital cellulites, or midface infection furuncle. This condition is uncommon but a serious one and affects both children and adults. The dural sinuses are grouped into the sagittal, lateral including the transverse, sigmoid, and petrosal sinuses, and cavernous sinuses. Diagnosis and management of cerebral venous thrombosis article pdf available in clinical medicine london, england 181. Cavernous sinus thrombosis is a very rare disorder in which a blood clot thrombosis forms in the cavernous sinus a large vein at the base of the skull. Cavernous sinus thrombosis cavernous sinus thrombosis is a specialised form of cerebral venous sinus thrombosis, where there is thrombosis of the cavernous sinus of the basal skull dura, due to the retrograde spread of infection and endothelial damage from the danger triangle of the face. These clots obstruct the vein in the aforementioned area of your body. Jul 16, 2018 cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. Mar 22, 2018 cavernous sinus thrombosis is a potentially lifethreatening condition that can happen after an infection in your head. Cavernous sinus thrombosis in ent practice juniper publishers. The diagnosis is based on case history and clinical presentation of the condition.
Its marked by a blood clot behind your eyes or at the base of your skull. It refers to the formation of a clot within the cavernous sinus. Cvt is a rare condition 1% of all strokes that is more common in females x3 risk and. Paired venous sinus, on either side of body of sphenoid. Vancomycin 1520 mgkg up to 2 g iv every 812 hours and. Septic cst is a rapidly evolving thrombophlebitic process with an infectious origin typically from the middle third of the face, sinuses, ears, teeth, or mouth, affecting the cavernous sinus and its structures. Rupture generally leads to carotid cavernous fistula and, rarely, to subarachnoid hemorrhage. Cavernous sinus thrombosis cst is a rare condition, usually results from a late. Patients now survive the disease more often than not, and therapy and diagnosis are reasonably clear cut. Local cavernous sinus aneurysm symptom control after carotid occlusion. Diagnosis and management of cerebral venous thrombosis. The signs and symptoms are extremely varied and nonspecific, being. Cavernous sinus thrombosis treatment algorithm bmj. Most commonly the form is of septic cavernous sinus thrombosis.
The initial localising features are unilateral chemosis, periorbital oedema, and eyelid swelling. 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. Infection is able to spread in this manner due to the anastomosis between the facial vein and superior ophthalmic veins. Dural sinus thrombosis is also thought to reduce cerebrospinal fluid absorption and thereby elevate intracranial pressure icp. Thrombosis of the dural sinus andor cerebral veins cvt is an uncommon form of stroke, usually affecting young individuals. Cavernous sinus thrombosis statpearls ncbi bookshelf. Cerebral venous sinus thrombosis postgraduate medical journal.
Despite treatment of cst is directed to the causal situation, being shown. The most common cause is an infection that spreads from. Even when a blood vessel is not injured, blood clots. Other causes include prothrombotic disorders, anemia and trauma. Dwi shows a small acute infarction in the right flocculus. An increasing array of antibioticresistant bacteria have been balanced by an increasing army of antibiotics. The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic. It is very often unrecognised at initial presentation. Recommendations on the evaluation and management of cerebral venous thrombosis during pregnancy and in the pediatric population are provided. The cavernous sinuses are hollow spaces located under the brain, behind each eye socket. A preliminary diagnosis of extensive intracranial venous thrombosis was confirmed on magnetic resonance imaging. Cavernous sinus thrombosis stellenbosch university. Postcontrast scans show absent blood flow in the left superior ophthalmic vein due to its thrombosis and dural thickening within left cavernous sinus caused by inflammation.
Important structures are located in, or run through the cavernous sinus,including the pituitary gland,cranial nerves 3,4 and 5 and the internal carotid arteries 2,3. Cavernous sinus thrombosis causes symptoms such as abnormally bulging eyes that occurs over days, swelling of the eyelid, severe headache, facial pain or numbness, impaired eye movements ophthalmoplegia with double vision, loss of vision, drowsiness, a high fever, and excessively dilated or uneven pupils. Infectious sinus venous thrombosis, although rare, has a much differ ent clinical course and treatment than noninfectious throm bosis. A major blood vessel called the jugular vein carries blood through the cavernous sinuses away from the brain. Septic cavernous sinus thrombosis wiley online library. Southwick 2016 septic dural sinus thrombosis, uptodate, accessed online 482016 2016 sanford guide, accessed on ipad app 482016. Cavernous sinus thrombosis symptoms, diagnosis and. The etiology is multifactorial and the presentation is variable, with diagnosis requiring a high index of suspicion. Cavernous sinus, thrombosis, management cite this article. Early recognition of cavernous sinus thrombosis which, often presents with fever, headache, eye findings such as periorbital swelling. Septic cavernous sinus thrombosisneurology and neurosciences.
In this study we report results of treatment in 85 patients with 86 cavernous sinus aneurysms. Treatment and management of venous sinus thrombosis. Indications for treatment included symptomatic idiopathic cavernous sinus aneurysms that. The initial localising features are unilateral chemosis, periorbital oedema. Cavernous sinus thrombosis approach bmj best practice. Ppt cavernous sinus thrombosis human head and neck. Infection can reach the cavernous sinus via either the. Cavernous sinus trombosis dr munish kumar g b pant delhi 2.
Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Diagnosis and management of cerebral venous thrombosis stroke. Cavernous sinus thrombosis an overview sciencedirect. Cavernous sinus thrombosis eye disorders msd manual. Cavernous sinus thrombosis is a potentially lifethreatening condition that can happen after an infection in your head. Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. Cavernous sinus thrombosis is an extremely rare complication of common facial infections, most notably nasal furuncles 50%, sphenoidal or ethmoidal sinusitis 30%, and dental infections 10%. The cavernous sinuses are trabeculated sinuses located at the base of the skull that drain venous blood from facial veins. Enlargement of the left cavernous sinus is seen on precontrast t1 coronals.
Symptoms and signs include pain, proptosis, ophthalmoplegia, vision loss, papilledema, and fever. Aneurysms of the cavernous segment of the internal carotid artery generally exhibit a benign clinical course, with mass effect on cranial nerves. If bacteria spread to the brain, more severe drowsiness, seizures, coma, and abnormal. Cavernous sinus thrombosis is a very serious condition. Cavernous sinus thrombosis is a condition where a blood clot forms in the region under your brain and at the back of the eye socket. Less commonly, infections of the ears or eyes may cause cavernous sinus thrombosis. Cavernous sinus thrombosis msd manual consumer version. Highest recanalization rates in deep cerebral veins and cavernous sinus thrombosis, lowest in lateral sinus thrombosis in adults, recanalization of the occluded sinus is not related to outcome saposnik et al. Cerebral venous sinus thrombosis postgraduate medical.
Intravenous heparin maintaining the partial thromboplastin time or thrombin clot time at. Cavernous sinus thrombosis radiology reference article. Cavernous sinus thrombosis is usually caused by the spread of bacteria from infections of the face and orbit including the skin of the nose, orbit, or sinus. This is a rare disorder and can be of two typesseptic cavernous thrombosis and aseptic cavernous thrombosis. The efficacy and safety of lowmolecularweight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis. Cavernous sinus thrombosis it doesnt happen often, but a blood clot can form in a vein that runs through the space behind your eye sockets. Cavernous sinus thrombosis or thrombophlebitis is a major life threatening complication of orofacial infections.
Extensive collateral circulation within the cerebral venous system allows for a significant degree of. Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. Cavernous sinus anatomy large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone. Intravenous heparin maintaining the partial thromboplastin time or thrombin clot time at 1. Cavernous sinus thrombosis is typically caused by an infection that has spread beyond the face, sinuses, or teeth. Cavernous sinus thrombosis cst is a rare condition, usually results from a late complication of an infection of the paranasal sinuses. Cavernous sinus thrombosis an overview sciencedirect topics. Cavernous sinus thrombosis this is rare, and can result from boils or. Wiedemann department of ophthalmology, university of leipzig, leipzig, germany to cite this article. Cavernous sinus thrombosis cst is a rare, lifethreatening 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. Large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone.
Considerations for the management of clinical complications seizures, hydrocephalus, intracranial hypertension, and neurological deterioration are also summarized. Syndromes of the orbital fissure, cavernous sinus, cerebello. When a blood vessel a vein or an artery is injured, the body uses platelets thrombocytes and fibrin to form a blood clot to prevent blood loss. Most common pathogens are staphylococcus aureus 70%, followed by.
Diagnosis and management of cerebral venous thrombosis rcp. You may want to print it out and provide it to them. Before the availability of antimicrobial agents, mortality from cst was near 100%, but it markedly decreased to. Efns guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Interior is divided into a number of spaces or caverns by trabeculae cavernous sinus anatomy boundaries anterior extends into medial end of. Early administration of heparin may serve to prevent spread of thrombosis to the other cavernous sinus as well as to the inferior and superior petrosal sinuses. Cavernous sinus thrombosis is a lifethreatening complication that may rarely result from infection spreading back through the emissary veins from the maxillary or nasal region, or upper teeth, or from infected thrombi in the anterior facial vein or less commonly the pterygoid plexus. Some people who survive will develop longterm health problems due to damage to their brain, such as persistent headaches and fits, or some degree of vision loss. Despite treatment of cst is directed to the causal situation, being shown that anticoagulation is associated with reduction in mortality. Cavernous sinus thrombosis is a blood clot in the cavernous sinuses. Because of the rarity of diagnosis, no randomized controlled trials are available. Septic thrombosis of the cavernous sinuses cardiology. Cavernous sinus thrombosis cst is the formation of thrombus clot within the cavernous sinus, which can either be septic or aseptic.
Cavernous sinus thrombosis eye disorders merck manuals. Cavernous sinus thrombosis cst is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. Cerebral venous thrombosis cvt refers to thrombus formation in either the deep or superficial venous drainage systems of the brain. Pdf diagnosis and management of cerebral venous thrombosis. Pdf cavernous sinus thrombosis a succinct outlook journal of. Endovascular treatment of cavernous sinus aneurysms. Nov 05, 2017 cavernous sinus thrombosis is a condition where a blood clot forms in the region under your brain and at the back of the eye socket. Cerebral vein and cerebral venous sinus thrombosis is an uncommon type of clot. Cavernous sinus thrombosis, cavernous sinus thromboses, sinus thromboses, cavernous, sinus thrombosis, cavernous, thromboses, cavernous sinus. Large sinuses such as the superior sagittal sinus are most frequently involved. It is the least common dural venous sinus thrombosis, accounting for of cases 4. Cavernous sinus thrombosis is a very rare but extremely dangerous major complication of head and neck infections. Cavernous sinus thrombosis symptoms, treatment, causes.
1311 356 210 108 1242 742 1057 1565 1477 1015 1414 1125 1531 571 186 825 1480 774 453 843 39 118 339 1055 54 1119 431 983 621 491 713 1530 1577 376 178 270 902 726 778 727 237 1213 45 392 427