Cavernous sinus thrombosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Physical examination of patients with cavernous sinus thrombosis is usually remarkable for high grade fever, Tachycardia with regular pulse, Tachypnea, low blood pressure with normal pulse pressure, Pallor of skin, Altered mental status, Periorbital edema (initially unilateral but typically bilateral), unilateral or bilateral exophthalmos, abnormal extra-ocular movements from third, fourth and sixth cranial neuropathy, non-reactive pupils to neither light nor accommodation (from paralysis of the iris and ciliary body), lid erythema, horner syndrome (ptosis, miosis, and anhidrosis), Chemosis, Ptosis, Proptosis (due to impaired venous drainage of orbit, painful eye movement, Papilledema, retinal hemorrhages, decreased visual acuity, Photophobia, pulsating conjunctiva, facial tenderness, impaired corneal reflex, blindness, stiff neck, Photophobia, Hyperreflexia, generalised weakness, downgoing plantar reflex, Ptosis and Hemiparesis.
Physical Examination
Appearance of the Patient
Vital Signs
- High-grade fever[2][3]
- Tachycardia with regular pulse[2][3]
- Tachypnea[4]
- Low blood pressure with normal pulse pressure
Skin
HEENT
- Periorbital edema (initially unilateral but typically bilateral)[5][2][3][6]
- Unilateral or bilateral exophthalmos[7][2][3][5]
- Extra-ocular movements may be abnormal from third, fourth and sixth cranial neuropathy[2][3][5]
- Sixth cranial nerve neuropathy is the most common neuropathy (resulting in partial ophthalmoplegia with limited eye abduction).[2][3][5]
- Pupils non-reactive to neither light nor accommodation (from paralysis of the iris and ciliary body)[5]
- Lid erythema[5]
- Horner syndrome (ptosis, miosis, and anhidrosis)[5][8]
- Chemosis[2][5]
- Ptosis[5][8]
- Proptosis (due to impaired venous drainage of orbit)[2][5]
- Painful eye movement[2][5]
- Papilledema[5]
- Retinal hemorrhages[5]
- Decreased visual acuity[5]
- Photophobia[1]
- Pulsating conjunctiva[2]
- Facial tenderness[2][3]
- Impaired corneal reflex[5][5]
- Blindness[9][10]
Neck
- Stiff neck may be present.[2]
Lungs
- Pulmonary examination of patients with cavernous sinus thrombosis is usually normal.
Heart
- Cardiovascular examination of patients with cavernous sinus thrombosis is usually normal.
Abdomen
- Abdominal examination of patients with cavernous sinus thrombosis is usually normal.
Back
- Back examination of patients with cavernous sinus thrombosis is usually normal.
Genitourinary
- Genitourinary examination of patients with cavernous sinus thrombosis is usually normal.
Neuromuscular
- Altered mental status[2][3]
- Extra-ocular movements may be abnormal from third, fourth and sixth cranial neuropathy[2][3][5]
- Sixth cranial nerve neuropathy is the most common neuropathy (resulting in partial ophthalmoplegia with limited eye abduction).[2][5]
- Photophobia[11]
- Horner syndrome (ptosis, miosis, and anhidrosis)[2][5][8]
- Hyperreflexia[12]
- Generalised weakness[1]
- Decreased visual acuity[10]
- Downgoing plantar reflex[13]
- Ptosis[5][8]
- Hemiparesis[13]
- Blindness[9][10]
Extremities
- Extremities examination of patients with cavernous sinus thrombosis is usually normal.
References
- ↑ 1.0 1.1 1.2 Goh KG, Shanthi V (2015). "The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report". Malays J Med Sci. 22 (5): 98–102. PMC 5295744. PMID 28239275.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 Arian M, Kamali A, Tabatabaeichehr M, Arashnia P (2016). "Septic Cavernous Sinus Thrombosis: A Case Report". Iran Red Crescent Med J. 18 (8): e34961. doi:10.5812/ircmj.34961. PMC 5068248. PMID 27781123.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Xia P, Jiao Y (2014). "Septic cavernous sinus thrombosis caused by tuberculosis infection". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-206209. PMC 4248139. PMID 25425249.
- ↑ Sacchetti F, Stagni S, Spinardi L, Raumer L, Dentale N, Cirillo L (2016). "A singular case of cavernous internal carotid artery aneurysm in patient with cavernous sinus syndrome and bacterial meningitis". Radiol Case Rep. 11 (3): 227–33. doi:10.1016/j.radcr.2016.05.005. PMC 4996927. PMID 27594955.
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 Visvanathan V, Uppal S, Prowse S (2010). "Ocular manifestations of cavernous sinus thrombosis". BMJ Case Rep. 2010. doi:10.1136/bcr.08.2009.2225. PMC 3028264. PMID 22802153.
- ↑ Senthilkumaran S, Balamurgan N, Arthanari K, Thirumalaikolundusubramanian P (2009). "Periorbital swelling in emergency room: Get your eyes in". J Emerg Trauma Shock. 2 (3): 209–10. doi:10.4103/0974-2700.55349. PMC 2776373. PMID 20009315.
- ↑ Kamawal A, Schmidt MA, Rompel O, Gusek-Schneider GC, Mardin CY, Trollmann R (2017). "[Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report]". Ophthalmologe. 114 (5): 457–461. doi:10.1007/s00347-016-0317-6. PMID 27401467.
- ↑ 8.0 8.1 8.2 8.3 Sweis R, Biller J (2016). "Cavernous Sinus Thrombosis in Children". Pediatr Neurol Briefs. 30 (1): 4. doi:10.15844/pedneurbriefs-30-1-3. PMC 4798854. PMID 27004138.
- ↑ 9.0 9.1 Ogundiya DA, Keith DA, Mirowski J (1989). "Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature". J Oral Maxillofac Surg. 47 (12): 1317–21. PMID 2685213.
- ↑ 10.0 10.1 10.2 Sharma S, Cruess AF (1996). "Central retinal vein occlusion associated with cavernous sinus thrombosis". Can J Ophthalmol. 31 (5): 255–6. PMID 8872381.
- ↑ PASCARELLI E, LEMLICH A (1964). "DIPLOPIA AND PHOTOPHOBIA AS PREMONITORY SYMPTOMS IN CAVERNOUS SINUS THROMBOSIS". Ann Otol Rhinol Laryngol. 73: 210–7. doi:10.1177/000348946407300123. PMID 14128709.
- ↑ Ekinci M, Çağatay HH, Hüseyinoğlu N, Ceylan E, Gökçe G (2014). "Optic Atrophy Secondary to Preseptal Cutaneous Anthrax: Case Report". Neuroophthalmology. 38 (4): 220–223. doi:10.3109/01658107.2013.874453. PMC 5123155. PMID 27928303.
- ↑ 13.0 13.1 Luo Y, Tian X, Wang X (2018). "Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review". Front Aging Neurosci. 10: 2. doi:10.3389/fnagi.2018.00002. PMC 5797620. PMID 29441008.