Cavernous sinus syndromes Flashcards
Where does the cavernous sinus run from and to?
It runs from the superior orbital fissure to the petrous temporal bone
What is medial to cavernous sinus?
Pituitary fossa
Sphenoid sinus
What lies lateral to the cavernous sinus?
Temporal lobe
What is in the cavernous sinus?
Occulomotor nerve
Trochlear nerve
Ophthalmic never
Maxillary nerve
Internal carotid artery and sympathetic plexus
Abudcens nerve
What is the blood supply of the cavernous sinus?
Ophthalmic vein, superficial cortical veins and basilar plexus of veins posteriorly
Drains into the internal jugular vein via the superior and inferior petrosal sinuses
What is cavernous sinus thrombosis?
Formation of clot in cavernous sinus can be septic or aseptic
What is septic cavernous sinus thrombosis?
Rapidly evolving thrombophlebitis process with an infectious origin- typically middle third of the face, sinuses, ears, teeth or mouth
What is aseptic cavernous sinus thrombosis?
Thrombotic process that is the result of trauma, iatrogenic injuries or pro-thrombotic conditions
RF for septic cavernous sinus thrombosis?
Recent hx of acute sinusitis
hx of facial infection
hx of orbital infection
RF for aseptic cavernous sinus thrombosis?
Genetic prothrombotic condition
Acquired prothombotic state
Presentation of cavernous sinus thrombosis?
Headache
Fever
Peri-orbital oedema
Chemosis and proptosis
Lateral gaze palsy
Opthalmoplegia
Profound sepsis (acute sepsis CT)
Ptosis and mydriasis
Papilloedema
Decreased corneal reflex
Mental state changes
Posticit kernigs or Brudzinskis signs
Investigations of CST?
FBC- leukocytosis in septic, may have DIC
CT- head with contrast- may have abnormal filling defects and later convexity of the cavernous sinuses
MRI head- expansion of cavernous sinuses, bowing of lateral walls
Blood culture- may be positive in septic
Anti-phospholipid- check for antiphospholipid syndrome
Clotting factors- may be high in aseptic
Management of CST?
antibiotics if septic + supportive therapy such as steroids + warfarin/heparin
Ddx of CST?
Peri- orbital/orbital cellulitis
Meningioma
Orbital apex syndrome
Superior orbital fissure syndrome
