Cavernous sinus thrombosis physical examination: Difference between revisions

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==Overview==
==Overview==
Physical examination of patients with cavernous sinus thrombosis is usually remarkable for high grade fever, [[Tachycardia]] with regular pulse, [[Tachypnea|Tachypnea, l]]<nowiki/>ow 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 [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy, non-reactive [[Pupil|pupils]] to neither light nor accommodation (from [[paralysis]] of the iris and [[ciliary body]]), lid [[erythema]], [[Horner's syndrome|horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]]), [[Chemosis]], [[Ptosis]], [[Proptosis]] (due to impaired venous drainage of [[orbit]], painful eye movement, [[Papilledema]], [[Retinal haemorrhage|retinal hemorrhages,]] decreased [[visual acuity]], [[Photophobia]], pulsating [[conjunctiva]], facial tenderness, impaired [[corneal reflex]], [[Blindness|blindness,]] [[Neck stiffness|stiff neck,]] [[Photophobia]], [[Hyperreflexia]], [[Weakness|generalised weakness]], downgoing [[plantar reflex]], [[Ptosis]] and [[Hemiparesis]].


==Physical Examination==
==Physical Examination==
Physical examination of patients with cavernous sinus thrombosis is usually remarkable for high [[fever]], [[Altered mental status|altered mental status,]] unilateral or bilateral [[exophthalmos]], [[periorbital edema]] (initially unilateral but typically bilateral), lid [[erythema]], [[chemosis]], [[ptosis]], [[proptosis]] (due to impaired venous drainage of [[orbit]]), restricted or painful eye movement, and less commonly [[Papilledema CT|papilledema]], [[Retinal haemorrhage|retinal hemorrhages]], [[decreased visual acuity]], [[photophobia]], diminished [[pupillary reflex]], and [[Conjunctival disease|pulsating conjunctiva]].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with cavernous sinus thrombosis usually appear very ill and toxic.  
*Patients with cavernous sinus thrombosis usually appear very ill and toxic.<ref name="pmid28239275">{{cite journal| author=Goh KG, Shanthi V| title=The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report. | journal=Malays J Med Sci | year= 2015 | volume= 22 | issue= 5 | pages= 98-102 | pmid=28239275 | doi= | pmc=5295744 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28239275  }} </ref><ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>


===Vital Signs===
===Vital Signs===


*High-grade fever
*High-grade fever<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
*[[Tachycardia]] with regular pulse
*[[Tachycardia]] with regular pulse<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
*[[Tachypnea]]
*[[Tachypnea]]<ref name="pmid27594955">{{cite journal| author=Sacchetti F, Stagni S, Spinardi L, Raumer L, Dentale N, Cirillo L| title=A singular case of cavernous internal carotid artery aneurysm in patient with cavernous sinus syndrome and bacterial meningitis. | journal=Radiol Case Rep | year= 2016 | volume= 11 | issue= 3 | pages= 227-33 | pmid=27594955 | doi=10.1016/j.radcr.2016.05.005 | pmc=4996927 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27594955  }} </ref>
*Low blood pressure with normal pulse pressure
*Low blood pressure with normal pulse pressure


=== Skin ===
=== Skin ===
* [[Pallor]] may be present
* [[Pallor]] may be present<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref>


===HEENT===
===HEENT===
* [[Periorbital edema]] (initially unilateral but typically bilateral)
* [[Periorbital edema]] (initially unilateral but typically bilateral)<ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref><ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid20009315">{{cite journal| author=Senthilkumaran S, Balamurgan N, Arthanari K, Thirumalaikolundusubramanian P| title=Periorbital swelling in emergency room: Get your eyes in. | journal=J Emerg Trauma Shock | year= 2009 | volume= 2 | issue= 3 | pages= 209-10 | pmid=20009315 | doi=10.4103/0974-2700.55349 | pmc=2776373 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20009315  }} </ref>
* Unilateral or bilateral [[exophthalmos]]
* Unilateral or bilateral [[exophthalmos]]<ref name="pmid27401467">{{cite journal| author=Kamawal A, Schmidt MA, Rompel O, Gusek-Schneider GC, Mardin CY, Trollmann R| title=[Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report]. | journal=Ophthalmologe | year= 2017 | volume= 114 | issue= 5 | pages= 457-461 | pmid=27401467 | doi=10.1007/s00347-016-0317-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27401467  }} </ref><ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
* Extra-ocular movements may be abnormal from [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy
* Extra-ocular movements may be abnormal from [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
** [[Sixth nerve palsy|Sixth cranial nerve neuropathy]] is the most common [[neuropathy]] (resulting in partial [[ophthalmoplegia]] with limited eye abduction).
** [[Sixth nerve palsy|Sixth cranial nerve neuropathy]] is the most common [[neuropathy]] (resulting in partial [[ophthalmoplegia]] with limited eye abduction).<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
*[[Pupil|Pupils]] non-reactive to neither light nor accommodation (from [[paralysis]] of the iris and [[ciliary body]])
*[[Pupil|Pupils]] non-reactive to neither light nor accommodation (from [[paralysis]] of the iris and [[ciliary body]])<ref name="pmid22802153" />
*Lid [[erythema]]
*Lid [[erythema]]<ref name="pmid22802153" />
*[[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]])
*[[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]])<ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
*[[Chemosis]]
*[[Chemosis]]<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
*[[Ptosis]]
*[[Ptosis]]<ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
*[[Proptosis]] (due to impaired venous drainage of [[orbit]])
*[[Proptosis]] (due to impaired venous drainage of [[orbit]])<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
*Painful eye movement
*Painful eye movement<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
*[[Papilledema]]
*[[Papilledema]]<ref name="pmid22802153" />
*[[Retinal haemorrhage|Retinal hemorrhages]]
*[[Retinal haemorrhage|Retinal hemorrhages]]<ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref>
*Decreased [[visual acuity]]
*Decreased [[visual acuity]]<ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref>
*[[Photophobia]]
*[[Photophobia]]<ref name="pmid28239275">{{cite journal| author=Goh KG, Shanthi V| title=The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report. | journal=Malays J Med Sci | year= 2015 | volume= 22 | issue= 5 | pages= 98-102 | pmid=28239275 | doi= | pmc=5295744 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28239275  }} </ref>
*Pulsating [[conjunctiva]]
*Pulsating [[conjunctiva]]<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref>
* Facial tenderness
* Facial tenderness<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
* Impaired [[corneal reflex]]
* Impaired [[corneal reflex]]<ref name="pmid22802153" /><ref name="pmid22802153">{{cite journal| author=Visvanathan V, Uppal S, Prowse S| title=Ocular manifestations of cavernous sinus thrombosis. | journal=BMJ Case Rep | year= 2010 | volume= 2010 | issue=  | pages=  | pmid=22802153 | doi=10.1136/bcr.08.2009.2225 | pmc=3028264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22802153  }} </ref>
* [[Blindness]]
* [[Blindness]]<ref name="pmid2685213">{{cite journal| author=Ogundiya DA, Keith DA, Mirowski J| title=Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature. | journal=J Oral Maxillofac Surg | year= 1989 | volume= 47 | issue= 12 | pages= 1317-21 | pmid=2685213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2685213  }} </ref><ref name="pmid8872381">{{cite journal| author=Sharma S, Cruess AF| title=Central retinal vein occlusion associated with cavernous sinus thrombosis. | journal=Can J Ophthalmol | year= 1996 | volume= 31 | issue= 5 | pages= 255-6 | pmid=8872381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872381  }} </ref>


===Neck===
===Neck===
*[[Neck stiffness|Stiff neck]] may be present.
*[[Neck stiffness|Stiff neck]] may be present.<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref>


===Lungs===
===Lungs===
Line 58: Line 57:
* Genitourinary examination of patients with cavernous sinus thrombosis is usually normal.
* Genitourinary examination of patients with cavernous sinus thrombosis is usually normal.
===Neuromuscular===
===Neuromuscular===
* [[Altered mental status]]
* [[Altered mental status]]<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref>
* Extra-ocular movements may be abnormal from [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy
* Extra-ocular movements may be abnormal from [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]] and [[Sixth nerve palsy|sixth]] cranial neuropathy<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid25425249">{{cite journal| author=Xia P, Jiao Y| title=Septic cavernous sinus thrombosis caused by tuberculosis infection. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25425249 | doi=10.1136/bcr-2014-206209 | pmc=4248139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425249  }} </ref><ref name="pmid22802153" />
** [[Sixth nerve palsy|Sixth cranial nerve neuropathy]] is the most common [[neuropathy]] (resulting in partial [[ophthalmoplegia]] with limited eye abduction).
** [[Sixth nerve palsy|Sixth cranial nerve neuropathy]] is the most common [[neuropathy]] (resulting in partial [[ophthalmoplegia]] with limited eye abduction).<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" />
* [[Photophobia]]
* [[Photophobia]]<ref name="pmid14128709">{{cite journal| author=PASCARELLI E, LEMLICH A| title=DIPLOPIA AND PHOTOPHOBIA AS PREMONITORY SYMPTOMS IN CAVERNOUS SINUS THROMBOSIS. | journal=Ann Otol Rhinol Laryngol | year= 1964 | volume= 73 | issue=  | pages= 210-7 | pmid=14128709 | doi=10.1177/000348946407300123 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14128709  }} </ref>
* [[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]])
* [[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]])<ref name="pmid27781123">{{cite journal| author=Arian M, Kamali A, Tabatabaeichehr M, Arashnia P| title=Septic Cavernous Sinus Thrombosis: A Case Report. | journal=Iran Red Crescent Med J | year= 2016 | volume= 18 | issue= 8 | pages= e34961 | pmid=27781123 | doi=10.5812/ircmj.34961 | pmc=5068248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27781123  }} </ref><ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
* [[Hyperreflexia]]
* [[Hyperreflexia]]<ref name="pmid27928303">{{cite journal| author=Ekinci M, Çağatay HH, Hüseyinoğlu N, Ceylan E, Gökçe G| title=Optic Atrophy Secondary to Preseptal Cutaneous Anthrax: Case Report. | journal=Neuroophthalmology | year= 2014 | volume= 38 | issue= 4 | pages= 220-223 | pmid=27928303 | doi=10.3109/01658107.2013.874453 | pmc=5123155 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27928303  }} </ref>
* [[Weakness|Generalised weakness]]
* [[Weakness|Generalised weakness]]<ref name="pmid28239275">{{cite journal| author=Goh KG, Shanthi V| title=The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report. | journal=Malays J Med Sci | year= 2015 | volume= 22 | issue= 5 | pages= 98-102 | pmid=28239275 | doi= | pmc=5295744 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28239275  }} </ref>
*Abnormal [[gait]]
*Decreased [[visual acuity]]<ref name="pmid8872381">{{cite journal| author=Sharma S, Cruess AF| title=Central retinal vein occlusion associated with cavernous sinus thrombosis. | journal=Can J Ophthalmol | year= 1996 | volume= 31 | issue= 5 | pages= 255-6 | pmid=8872381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872381  }} </ref>
*Decreased [[visual acuity]]
*Downgoing [[plantar reflex]]<ref name="pmid29441008">{{cite journal| author=Luo Y, Tian X, Wang X| title=Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. | journal=Front Aging Neurosci | year= 2018 | volume= 10 | issue=  | pages= 2 | pmid=29441008 | doi=10.3389/fnagi.2018.00002 | pmc=5797620 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29441008  }} </ref>
*Downgoing [[plantar reflex]]
*[[Ptosis]]<ref name="pmid22802153" /><ref name="pmid27004138">{{cite journal| author=Sweis R, Biller J| title=Cavernous Sinus Thrombosis in Children. | journal=Pediatr Neurol Briefs | year= 2016 | volume= 30 | issue= 1 | pages= 4 | pmid=27004138 | doi=10.15844/pedneurbriefs-30-1-3 | pmc=4798854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27004138  }} </ref>
*[[Ptosis]]
*[[Hemiparesis]]<ref name="pmid29441008">{{cite journal| author=Luo Y, Tian X, Wang X| title=Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. | journal=Front Aging Neurosci | year= 2018 | volume= 10 | issue=  | pages= 2 | pmid=29441008 | doi=10.3389/fnagi.2018.00002 | pmc=5797620 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29441008  }} </ref>
*[[Hemiparesis]]
* [[Blindness]]<ref name="pmid2685213">{{cite journal| author=Ogundiya DA, Keith DA, Mirowski J| title=Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature. | journal=J Oral Maxillofac Surg | year= 1989 | volume= 47 | issue= 12 | pages= 1317-21 | pmid=2685213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2685213  }} </ref><ref name="pmid8872381">{{cite journal| author=Sharma S, Cruess AF| title=Central retinal vein occlusion associated with cavernous sinus thrombosis. | journal=Can J Ophthalmol | year= 1996 | volume= 31 | issue= 5 | pages= 255-6 | pmid=8872381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872381  }} </ref>


===Extremities===
===Extremities===

Latest revision as of 15:42, 5 July 2018

Cavernous sinus thrombosis Microchapters

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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

  • Patients with cavernous sinus thrombosis usually appear very ill and toxic.[1][2][3]

Vital Signs

Skin

HEENT

Neck

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

Extremities

  • Extremities examination of patients with cavernous sinus thrombosis is usually normal.

References

  1. ↑ 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. ↑ 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. ↑ 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.
  4. ↑ 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. ↑ 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.
  6. ↑ 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.
  7. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  11. ↑ 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.
  12. ↑ 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. ↑ 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.

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