Cavernous sinus thrombosis

Typically a late complication of central face or paranasal sinus infection.

May be a complication of bacteremia, facial trauma, or infections of the ear or maxilla.

Occurs in all races and equal among genders with a mean age of 22 years.

Associated with high rates of morbidity and mortality.

Mortality rate for untreated septic cavernous sinusapproaches 100%, but with treatment drops to 20-30%.

Incidence decreasing sharply as a result of use of antibiotics.

The cavernous sinuses are connected trabeculated cavities at the base of skull which lie on either side of the sella turcica, superolateral to the sphenoid sinuses and posterior to the optic chiasma.

Cavernous sinuses receive venous blood from facial veins, middle cerebral veins and sphenoid veins.

Cavernous sinuses empty into inferior petrosal sinuses, which empty into internal jugular veins and sigmoid sinuses.

Sinuses most commonly involved are the sphenoidal and ethmoidal sinuses.

Cavernous complex of veins have no valves and blood flow can be in any direction depending on pressure gradients.

The internal carotid artery passes through the cavernous sinus.

The third, fourth and sixth cranial nerves are attached the lateral wall of the sinus.

The fifth cranial nerve’s ophthalmic and maxillary divisions are embedded in the wall of the sinus.

The juxtaposition of veins, arteries, nerves, meninges and sinuses account for process.

Staphylococcus aureus associated in 70% of infections.

Other organisms associated with infection include Streptococcus pneumoniae and anaerobes.

Streptococcal species identified in 17% of cases.

Fungi may be responsible in some cases and include Aspergillus and Rhizopus species.

Prior to antibiotics mortality rate was essentially 100% from sepsis or CNS infection.

Mortality rate today 30% with significant morbidity rate with one sixth of patients with residual visual impairment and one half with cranial nerve deficits.

Headache is the most common presentation that precedes fever, periorbital swelling and cranial nerve changes.

Anticoagulants should be used if there are no hemorrhagic sequelae.

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