Cavernous sinus thrombosis: Difference between revisions
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*Low frequency, but high rate of morbidity/mortality | *Low frequency, but high rate of morbidity/mortality | ||
== Causes == | === Causes === | ||
*Staph aureus | *[[Staph aureus]] | ||
*[[Strep pneumoniae]] | |||
*[[Gram negative]] bacilli | |||
*[[Anaerobes]] | |||
*[[Fungi]] | |||
== Clinical Features == | == Clinical Features == |
Revision as of 11:00, 4 September 2015
The cavernous sinus is one of the several cerebral veins and cavernous sinus thrombosis is a specific type of cerebral venous (sinus) thrombosis. See that article for a discussion of the larger clinical entity.
Background
- Severe infection involving complications of paranasal sinus and facial infections (e.g. manipulated midface abscesses, furuncles)
- Frequent extension of thrombosis to opposite sinus
- Low frequency, but high rate of morbidity/mortality
Causes
Clinical Features
- Fevers, chills, N/V, headache
- Eye exam
- infraorbital/periorbital cellulitis
- Exophthalmos (uni/bl)
- Decreased vision
- Absent pupillary reflexes
- Decreased EOM 2/2 CN III, IV, VI
- CN VI typically affected 1st causing lateral gaze palsy
- Decreased corneal sensation 2/2 CN V
- If infection spreads into CNS: AMS, lethargy, meningeal signs
Work Up
- MRI with MR Venogram - study of choice
- CT head/orbits with IV contrast
- CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT
- Blood Cx
DDx
- Aneurysmal dilation/rupture of internal carotid artery in cavernous sinus
- Cellulitis
- Periorbital vs Orbital Cellulitis
- Acute Angle-Closure Glaucoma
- Sinusitis
Treatment
- IV antibiotics:
- 3rd generation cephalosporin and:
- Nafcillin or vancomycin/linezolid if suspected MRSA and
- Anaerobic coverage if suspected dental source
- Consider heparin if rapidly decompensating and CT neg for intracranial hemorrhage
- Consider steroids to decrease inflammation in conjunction with antibiotics
- Surgical drainage of primary infection if possible
Disposition
- Consult ophthalmology, neurology, ID, surgery specialty (if drainage is needed) and admit ICU
Complications
- Meningitis, septic emboli, remaining visual defects, CNS deficit, pituitary insufficiency
See Also
Source
- Harwood and Nuss
- Tintinalli
- Emedicine