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cavernous sinus thrombosis

also see cerebral vein thrombosis Etiology: - contiguous spread of infection from sinus infection, dental infection - Staphylococcus aureus in 70% [3] Pathology: - thrombosis of the cavernous sinus(es) - involvement of cranial nerve 3, cranial nerve 4 & cranial nerve 6 Clinical manifestations: 1) ptosis 2) chemosis 3) painful ophthalmoplegia 4) retro-orbital throbbing headache 5) periorbital edema 6) diplopia 7) ocular paralysis - cranial nerve 3 palsy, cranial nerve 4 palsy & cranial nerve 6 palsy [4] 8) facial numbness., cranial nerve 5 palsy [4] 9) partial Horner's syndrome [4] Laboratory: - complete blood count (CBC) Special laboratory: - lumbar puncture with CSF analysis (exclude meningitis) Radiology: - MRI neuroimaging [3] - magnetic resonance venography may be helpful Management: - life threatening - antibiotic coverage for Staphylococcus aureus - neurosurgical drainage

Related

cavernous sinus (parasellar sinus) cavernous sinus syndrome

General

cerebral venous thrombosis; dural sinus thrombosis

References

  1. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  2. Pikija S, Mutzenbach JS Septic Cerebral Venous Thrombosis. N Engl J Med 2015; 373:1553. October 15, 2015 PMID: 26465988 http://www.nejm.org/doi/full/10.1056/NEJMicm1415937
  3. Medical Knowledge Self Assessment Program (MKSAP) 18, 19. American College of Physicians, Philadelphia 2018, 2021
  4. NEJM Knowledge+ Question of the Week Feb 18, 2020 https://knowledgeplus.nejm.org/question-of-week/1356/