Cavernous Sinus Thrombosis

Cavernous Sinus Thrombosis

Definition

Rare but severe acute clinical syndrome in which the spaces of the cavernoussinus posterior to the orbital cavity become thrombosed, usually in the pres-ence of adjacent purulent processes. This is not an orbital disorder in the strict sense.

Etiology: 

These are purulent inflammations that have spread from themiddle ear, petrous bone, orbital cavities, or from the facial skin via the angu-lar vein.

Symptoms: 

Patients present with an acute clinical picture with headache,stupor, fever, and vomiting.

Clinical findings: 

The ophthalmologist will usually diagnosebilateral exoph-thalmos and episcleral and conjunctival venous stasis in combination withmultiple pareses of the cranial nerves. Neurogenic paralysis of all ocularmuscles is referred to astotal ophthalmoplegia. Where the optic nerve is also involved, the condition is referred to asorbital apex syndrome.

The limited motility of the globe is primarily neurogenic and due to damage to the nerves in the cavernous sinus as opposed to the mechanical limitation of motility due to the orbital inflammation in orbital cellulitis.

Diagnostic considerations and treatment: 

This lies primarily in the handsof ENT specialists, neurosurgeons, and internists. High-dose systemic anti-biotic therapy and anticoagulation are indicated.