A CAVERNOUS SINUS THROMBOSIS
A CAVERNOUS SINUS THROMBOSIS is a life-threatening condition in which a blood clot develops in a part of the skull called the cavernous sinuses as a result of bacteria spreading from a dental abscess. It is estimated that 1 in 10 cases of cavernous sinus thrombosis begin as a dental infection.
Running through the sinuses is a major blood vessel called the jugular vein whose role is to carry blood away from the brain and back to the heart and lungs. Most cases of cavernous sinus thrombosis are caused when a bacterial infection (or much less commonly, a fungal infection) in another part of the skull spreads into the cavernous sinuses. The immune system will then create a blood clot inside the cavernous sinuses to prevent the infection from spreading.
The blood clot can then place the brain under increasing pressure, which can damage the brain and, without treatment, will inevitably prove fatal.
Symptoms of a cavernous sinus thrombosis include: a sharp and severe headache, eye pain that is often severe, decrease or loss of vision, chemosis, exophthalmos (bulging eyes), and paralysis of the cranial nerves which course through the cavernous sinus.
The main treatment for cavernous sinus thrombosis is antibiotics, which are normally provided through a drip that is directly connected to a vein in the arm.
Most people will require at least a 3-4 week course of antibiotics to ensure that the infection has been fully cleared from their body.
In severe cases, it can be treated with surgery to drain the sinus
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. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth.Staphylococcus aureus and Streptococcus are often the associated bacteria. Cavernous sinus thrombosis symptoms include: decrease or loss of vision, chemosis, exophthalmos (bulging eyes), headaches, and paralysis of the cranial nerves which course through the cavernous sinus. This infection is life-threatening and requires immediate treatment, which usually includes antibiotics and sometimes surgical drainage.
A CAVERNOUS SINUS THROMBOSIS is a life-threatening condition in which a blood clot develops in a part of the skull called the cavernous sinuses as a result of bacteria spreading from a dental abscess. It is estimated that 1 in 10 cases of cavernous sinus thrombosis begin as a dental infection.
Running through the sinuses is a major blood vessel called the jugular vein whose role is to carry blood away from the brain and back to the heart and lungs. Most cases of cavernous sinus thrombosis are caused when a bacterial infection (or much less commonly, a fungal infection) in another part of the skull spreads into the cavernous sinuses. The immune system will then create a blood clot inside the cavernous sinuses to prevent the infection from spreading.
The blood clot can then place the brain under increasing pressure, which can damage the brain and, without treatment, will inevitably prove fatal.
Symptoms of a cavernous sinus thrombosis include: a sharp and severe headache, eye pain that is often severe, decrease or loss of vision, chemosis, exophthalmos (bulging eyes), and paralysis of the cranial nerves which course through the cavernous sinus.
The main treatment for cavernous sinus thrombosis is antibiotics, which are normally provided through a drip that is directly connected to a vein in the arm.
Most people will require at least a 3-4 week course of antibiotics to ensure that the infection has been fully cleared from their body.
In severe cases, it can be treated with surgery to drain the sinus
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. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth.Staphylococcus aureus and Streptococcus are often the associated bacteria. Cavernous sinus thrombosis symptoms include: decrease or loss of vision, chemosis, exophthalmos (bulging eyes), headaches, and paralysis of the cranial nerves which course through the cavernous sinus. This infection is life-threatening and requires immediate treatment, which usually includes antibiotics and sometimes surgical drainage.
Clinical features[edit]
The clinical presentation of CST can be varied. Both acute, fulminant disease and indolent, subacute presentations have been reported in the literature.
The most common signs of CST are related to anatomical structures affected within the cavernous sinus, notably cranial nerves III-VI, as well as symptoms resulting from impaired venous drainage from the orbit and eye.
Classic presentations are abrupt onset of unilateral periorbital edema, headache, photophobia, and bulging of the eye (proptosis).
Other common signs and symptoms include:
Ptosis, chemosis, cranial nerve palsies (III, IV, V, VI). Sixth nerve palsy is the most common. Sensory deficits of the ophthalmic and maxillary branch of the fifth nerve are common. Periorbital sensory loss and impaired corneal reflex may be noted. Papilledema, retinal hemorrhages, and decreased visual acuity and blindness may occur from venous congestion within the retina. Fever,tachycardia and sepsis may be present. Headache with nuchal rigidity may occur. Pupil may be dilated and sluggishly reactive. Infection can spread to contralateral cavernous sinus within 24–48 hours of initial presentation.
Etiology[edit]
CST most commonly results from contiguous spread of infection from a nasal furuncle (50%), sphenoidal or ethmoidal sinuses (30%) and dental infections (10%).[1] Less common primary sites of infection include tonsils, soft palate, middle ear, or orbit (orbital cellulitis).
The highly anastomotic venous system of the paranasal sinuses allows retrograde spread of infection to the cavernous sinus via the superior and inferior ophthalmic veins. It was previously thought that veins in the area were valveless and that this was the major cause of the retrograde spread, however, a recent study has found that the ophthalmic and facial veins are not valveless.[2]
The highly anastomotic venous system of the paranasal sinuses allows retrograde spread of infection to the cavernous sinus via the superior and inferior ophthalmic veins. It was previously thought that veins in the area were valveless and that this was the major cause of the retrograde spread, however, a recent study has found that the ophthalmic and facial veins are not valveless.[2]
Staphylococcus aureus is the most common infectious microbe, found in 70% of the cases.[1] Streptococcus is the second leading cause. Gram-negative rods and anaerobes may also lead to cavernous sinus thrombosis. Rarely, Aspergillus fumigatus and mucormycosis cause CST.
Diagnosis[edit]
The diagnosis of cavernous sinus thrombosis is made clinically, with imaging studies to confirm the clinical impression. Proptosis, ptosis, chemosis, and cranial nerve palsy beginning in one eye and progressing to the other eye establish the diagnosis.
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