Treatment of cavernous sinus thrombosis septic cavernous sinus thrombosis the mainstay of therapy is early and aggressive antibiotic administration. Our case highlights that the diagnosis of cavernous sinus thrombosis complicating sinusitis and periorbital cellulitis requires a high index of. Traversed by numerous trabeculae, dividing it into a several caverns spaces, hence cavernous sinus relations. Cavernous sinus thrombosis cst is a rare infective disease. 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.
Affecting the cavernous sinus and its structures, septic cst is a rapidly evolving thrombophlebitic process with an infectious origin, usually from the middle third of the face, sinuses, ears, mouth or teeth. The first description of intracranial venous sinus thrombosis is believed to have been reported by duncan, in 1821, involving a case of cavernous sinus thrombosis detected at autopsy chisolm and watkins, 1920. Cvst usually occurs young adults with a female predominance. Diagnosis and management of cerebral venous thrombosis ncbi. Cavernous sinus thrombosis treatment algorithm bmj. This is a rare disorder and can be of two typesseptic cavernous thrombosis and aseptic cavernous thrombosis.
It functions to drain deoxygenated blood from the brain, which is carried back to the heart by veins. Cavernous sinus thrombosis caused by contralateral. Although s aureus is the usual cause, broadspectrum coverage for grampositive, gramnegative, and anaerobic organisms should be instituted pending the outcome of cultures empiric antibiotic therapy should include a penicillinaseresistant penicillin plus a third or fourthgeneration. The cavernous sinuses consist of extradural venous plexuses surrounded by a dural fold. Less commonly, infections of the ears or eyes may cause cavernous sinus thrombosis. It can be classified as septic or aseptic, depending on its aetiology. Cavernous sinus thrombosis is a blood clot in an area at the base of the brain. Sigmoid sinus thrombosis associated to chronic otitis media scielo. Thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. Review article cerebral venous thrombosis clinical presentations man mohan mehndiratta1, siddhartha garg2, mayank gurnani3 department of neurology, g. Cavernous sinus thrombosis cst is a rare condition, usually results from a late complication of an infection of the paranasal sinuses.
Review article cerebral venous thrombosis clinical. A condition in which a blood clot forms in the large vein at the base of the brain. Most commonly the form is of septic cavernous sinus thrombosis. This is a life threatening disease and requires immediate treatment. Interior is divided into a number of spaces or caverns by trabeculae cavernous sinus anatomy boundaries anterior extends into medial end of. Tips for avoiding cavernous sinus thrombosis shm abstracts. Endovascular treatments for cerebral venous sinus thrombosis. There is individual variation in the curvature of the intracavernous carotid. Cavernous sinus thrombosis cst is a rare condition, with few cases described in the literature. Although it was associated with high mortality and morbidity rates in the preantibiotic era, these rates have remained high in the modern era. The mainstay of therapy for cavernous sinus thrombosis is early and aggressive antibiotic administration. Bilateral cavernous sinus thrombosis complicating sinusitis. This usually develops as a sharp pain located behind or around the eyes that steadily gets worse over time.
Cerebral venous thrombosis cvt, also called cerebral venous sinus thrombosis cvst, is a cerebrovascular disease with diverse clinical. Treatment cavernous sinus thrombosis is treated with highdose antibiotics given through a vein iv if an infection is the cause. Treatment options are limited and are mostly based on consensus. Endovascular treatment of the cavernous sinus dural arteriovenous fistula. Early recognition of cavernous sinus thrombosis which, often presents with fever, headache, eye findings such as periorbital swelling. The blood drains it into other blood vessels that carry it back to the heart. Intravenous heparin maintaining the partial thromboplastin time or thrombin clot time at 1. Other causes include prothrombotic disorders, anemia and. 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. The clinical findings of sudden proptosis, accompanied by erythema of the eyelid, chemosis, history of proptosis, and restricted ocular. Any information contained in this pdf file is automatically generated from digital material. Departmental guidelines anatomy cavernous sinus 2cm in length, height of 1cm paired venous sinus, on either side of body of sphenoid.
Cavernous sinus trombosis dr munish kumar g b pant delhi 2. Cavernous sinus thrombosis is a serious and lifethreatening condition. 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 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. Brain mri is the most sensitive exam for identifying occlusions with ct venography as an. The abducens nerve runs lateral to the internal carotid artery, but medial to the oculomotor and trochlear nerves and the ophthalmic and maxillary. The intracavernous internal carotid artery with its periarterial sympathetic plexus runs between the venules of the parasellar venous plexus fig. At post mortal examination, abercrombie identified a thrombosis of the superior sagittal sinus and cortical veins. Cavernous sinus thrombosis cst is the formation of thrombus within the cavernous sinus, which could be septic or aseptic. Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. Cavernous sinus thrombosis eye disorders merck manuals.
Symptoms often start within a few days of developing an infection in the face or skull, such as sinusitis or a boil. Cavernous sinus thrombosis, odontogenic focus, infection disease introduction the cavernous sinus cs is an important sinus for drainage of the brain. Clinical aspects and treatment were reported based on. Symptoms and signs include pain, proptosis, ophthalmoplegia, vision loss, papilledema, and fever. Treatment for cavernous sinus thrombosis includes highdose intravenous antibiotics directed at the most common causative organisms, coupled with surgical drainage of the primary source of infection. Cavernous sinus anatomy large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone. 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. Cerebral sinus venous thrombosis csvt is a rare phenomenon that can be seen with some frequency in young patients. Large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone. Csvt is a multifactorial condition with genderrelated specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting csvt in a condition characterized by a highly variable clinical spectra, difficult. Therefore, familiarity with international guidelines is important. Patients with severe papilledema may develop permanent vision deficits without treatment.
Opg examination revealed periapical pathology in relation to left maxillary central incisor culprit tooth along with multiple carious. Cavernous sinus thrombosis the veins of the face drain blood into the cavernous sinus via the superior ophthalmic vein. Symptoms may include headache, abnormal vision, seizures, and any of the symptoms of stroke such as weakness. Cavernous sinus thrombosis images bmj best practice. A cerebral venous sinus thrombosis cvst occurs when a blood clot forms in the dural venous sinuses, which drain blood from the brain. 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. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be underdiagnosis. Cavernous sinus thrombosis is a very rare but extremely dangerous major complication of head and neck infections. Cavernous sinus thrombosis tips and tricks from doctors. As such, infections of the face particularly those involving the danger triangle orbits, nasal sinuses, and superior part of the face can cause a cavernous sinus thrombosis. Cavernous sinus thrombosis is a blood clot in the cavernous sinuses. It is dual, symmetrical, and located laterally to the sella turcica of the sphenoid bone in the middle cranial fossa.
Treatment of csvt includes treatment for avoiding increase in thrombosis, raised intracranial tension, headache and seizures. Other causes include prothrombotic disorders, anemia and trauma. The most common initial symptom of cavernous sinus thrombosis is a headache. Cavernous sinus thrombosis symptoms, diagnosis and. However, more aggressive interventions, endovascular treatment as an example, may be indicated in selected patients who are nonresponsive to heparin and other. Septic cavernous sinus thrombosis with diffuse spread leading to. Cerebral venous sinus thrombosis cvst is an uncommon but potentially fatal condition. Importantly, head ct is normal in up to 30% of cases. Cavernous sinus thrombosis or cst, is the formation of a blood clot in cavernous sinus, which is a cavity at the base of the brain. Cavernous sinus thrombosis statpearls ncbi bookshelf. Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection. The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic.
There are few authors who argued 64 acofs cavernous sinus thrombosis. Cavernous sinus thrombosis cst is the formation of thrombus clot within the cavernous sinus, which can either be septic or aseptic. A cst is generally a sudden and severe process with high rates of morbidity and mortality. Surgery is sometimes needed to drain the infection. This area also contains nerves that control vision and eye movements. Treatment and management of venous sinus thrombosis. The cavernous sinuses are cavities located at the base of the skull. Ribes, in 1825, described thrombosis of the superior sagittal sinus, the left transverse sinus, and a parietal. The major arterial structure within the cavernous sinus is the internal carotid artery. Its marked by a blood clot behind your eyes or at the base of your skull. Cerebral sinus venous thrombosis pubmed central pmc. Thrombosis of the cavernous sinus is a life threatening disorder as it is highly infectious and maybe lethal despite the use of antibiotics.
Review endovascular treatment of the cavernous sinus dural. Treatment of venous thromboembolism vte is aimed to prevent thrombus extension and embolization and to reduce the risk of recurrence. Diagnosis and treatment of cerebral venous thrombosis. Abstract cerebral venous thrombosis cvt is an under diagnosed condition for acute or slowly progressive neurological deficit. Blood thinners help dissolve the blood clot and prevent it from getting worse or recurring. Proptosis of the right eye in a patient with cavernous sinus thrombosis secondary to dental infection. A new treatment approach for cavernous sinus thrombosis. Infectious cavernous sinus thrombosis, as in this patient, classically causes headache, fever, and eye symptoms.
Thank you for your interest in spreading the word about the bmj. Cavernous sinus thrombosis eye disorders msd manual. Cavernous sinus thrombosis is typically caused by an infection that has spread beyond the face, sinuses, or teeth. Cavernous sinus thrombosis is a potentially lifethreatening condition that can happen after an infection in your head. Cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. Treated patients may suffer from blindness, oculomotor weakness or pituitary insufficiency. A cavernous sinus thrombosis is usually a complication of an infection of the central face, paranasal sinuses, bacteremia, trauma, and infections of the ear or maxillary upper teeth. The current mainstay for treating cvst is anticoagulation with heparin. Cavernous sinus thrombosis an overview sciencedirect. Otogenous lateral sinus thrombosis olst is a rare disease and presents a controversial treatment. Department of neurosurgery, the first hospital of jilin university, changchun, 021, china 2. Update on management of cerebral sinus venous thrombosis.
Subarachnoid haemorrhage in patients with cerebral venous sinus. 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. Review article cavernous sinus thrombosis of odontogenic. The survivors often suffer from permanent sequelae. The signs and symptoms are extremely varied and nonspecific, being the diagnosis made through magnetic resonance imaging mri.
Cavernous sinus thrombosis is a very serious condition. Ppt cavernous sinus thrombosis human head and neck. The dural sinuses are grouped into the sagittal, lateral including the transverse, sigmoid, and petrosal sinuses, and cavernous sinuses. Although s aureus is the usual cause, broadspectrum coverage for gram positive, gramnegative, and anaerobic organisms should be instituted pending the outcome of cultures. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Recognition of risk factors, symptoms and its treatment can provide full recovery from neurological sequela. Summary cavernous sinus contains cn 3,4,5,6 and internal carotid artery cavernous sinus thrombosis is divided into septic and aseptic cst is mainly due to bacterial infections thrombus is formed to prevent further spread of bacteria patient with diabetes mellitus or women who take contraceptive pills are at higher risk. However, the ef ficacy of this treatment is not well established. 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. Cerebral venous sinus thrombosis cvst accounts for 0. 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.
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