Cavernous Sinus Thrombosis

The most common cause of cavernous sinus thrombosis is sphenoid or ethmoid sinusitis. Treatment consists of highdose, broad-spectrum intravenous antibiotics and an ENT referral for surgical drainage. Careful attention to the HEENT examination often suggests this unusual entity. Rapid treatment and surgical consultation are key. The structures passing through the cavernous sinus include the third and fourth cranial nerves, ophthalmic and maxillary divisions of fifth and sixth cranial nerves, and the internal carotid artery with its sympathetic plexus.

Causes

• The main cause of cavernous sinus thrombosis is bacterial infection that has spread from the sinuses, ears, eyes, nose, or skin of the face.
• Mostly the cause of cavernous sinus thrombosis by Streptococcal and Staphylococcal bacterial infections.
• Common cause of spread of infection into a cavernous sinus is from squeezing a pimple.
• It may also cause edema of the eyelids and the conjunctivae of the eyes and paralysis of the cranial nerves.

Symptoms

• Headache: severe, frontal or retro-orbital pain
• Diplopia
• Vomiting, seizures, hemiplegia, dysarthria, and altered mental status are not as commonly seen as in other cerebral venous thromboses.

Signs

• Chemosis, proptosis, or ptosis ++++
• Periorbital or orbital edema: progressive unilateral or bilateral
• Isolated abducens nerve palsy or involvement of third, fourth, and fifth cranial nerves and paresthesia of VIN2 distribution
• Fever
• Funduscopy: venous engorgement, papilledema
• Meningismus +++

Treatment

For the treatment of cavernous sinus thrombosis condition, you should take high doses of drugs which are given immediately after diagnosis. If the condition does not improve, then sinus may be drained surgically.