Cavernous sinus thrombosis pathophysiology: Difference between revisions

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{{Cavernous sinus thrombosis}}
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==Pathophysiology==
==Pathophysiology==
===Physiology===
The cavernous sinus which is a true dural venous sinus, is irregularly shaped, trabeculated cavities in the base of the skull.
The normal physiology of [name of process] can be understood as follows:
 
===Pathogenesis===
*The exact pathogenesis of [disease name] is not completely understood.
OR
*It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
*Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
*[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
*The progression to [disease name] usually involves the [molecular pathway].
*The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Genetics==
The cavernous sinus receives blood via the superior and inferior ophthalmic veins through the:
[Disease name] is transmitted in [mode of genetic transmission] pattern.
* Superior orbital fissure
* Superficial cortical veins
Cavernous sinus is connected to the basilar plexus of veins posteriorly.


OR
There are some important nerves and arteries pass through the cavernous sinus, include:
* The internal carotid artery (carotid siphon)
* Cranial nerve III
* Cranial nerve IV
* Cranial nerve V branches:
** Branch V<sub>1</sub>
** Branch V<sub>2</sub>
* Cranial nerve VII
Infection from the face may reach the cavernous sinus through its many anastomotic connections, with severe consequences. The cavernous sinus drains by two larger channels, the superior and inferior petrosal sinuses, ultimately into the internal jugular vein via the sigmoid sinus, also draining with emissary vein to pterygoid plexus. These sinuses are just lateral and superior to the sphenoid sinus and are immediately posterior to the optic chiasm. Each cavernous sinus is formed between layers of the dura mater, and multiple connections exist between the 2 sinuses.


Genes involved in the pathogenesis of [disease name] include:
===Pathogenesis===
*[Gene1]
*It is understood that the main cause of cavernous sinus thrombosis is bacterial infections.
*[Gene2]
**Staphylococcus aureus may account for two-thirds of cases of cavernous sinus thrombosis.
*[Gene3]
**Other typical organisms include:
***Streptococcus species (approximately 20% of cases)
***Pneumococcus (5%)
***Gram-negative species such as Proteus
***Hemophilus
***Pseudomonas
***Fusobacterium
***Bacteroides
***Gram-positive species such as Corynebacterium and Actinomyces


OR
* In cavernous sinus thrombosis, a blood clot develops in the sinus cavernous structure to prevent the infection from spreading to brain, but it often blocks the blood flow out of the brain.


The development of [disease name] is the result of multiple genetic mutations such as:
* Septic cases of cavernous sinus thrombosis are usually caused by central facial infections, especially within the danger triangle of the face (from the corners of the mouth to the bridge of the nose.
* The main sources of infection include:
** Mastoiditis
** Otitis media
** Abscess
** Cellulitis
** Sinusitis
** Dental infections or procedures (even a posterior superior alveolar nerve block entering the pterygoid plexus)
** Maxillofacial surgery


*[Mutation 1]
* The other rare causes of cavernous sinus thrombosis include:
*[Mutation 2]
**Fungal infections
*[Mutation 3]
**Severe head injuries
**Autoimmune conditions such as lupus
**Pregnancy


==Associated Conditions==
==Associated Conditions==
==Gross Pathology==
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
==Microscopic Pathology==
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].


==References==
==References==
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[[Category: (name of the system)]]
== Pathophysiology ==
===Anatomy===
* Anatomy:
*:* ''Cerebral veins'' --> ''Dural sinuses'' --> ''Internal jugular veins''
*:* The ''Cerebral veins'' include:
*:*:* Superficial cerebral veins
*:*:*:* Anatomy quite variable
*:*:* Deep cerebral veins
*:*:* Veins of the posterior fossa
*:* The ''Dural sinuses'' most commonly affected by thrombosis are:
*:*:* Superior sagital sinus
*:*:*:* Drains most of cortex
*:*:*:* Also fed by scalp emissary veins
*:*:*:* Contains most of arachnoid villi responsible for draining CSF – obstruction increases intracerebral pressure
*:*:*:* Superior sagital sinus thrombosis may only result in massive brain edema.
*:*:* Lateral sinus
*:*:*:* Drains cerebellum, brain stem, posterior cerebral hemispheres, middle ear
*:*:*:* Near mastoid and inner ear, and susceptible to infections there
*:*:* Cavernous sinus
*:*:*:* Drains ophthalmic veins, anterior base of brain
*:*:*:* Near, and susceptible to infection of face, sphenoid sinuses, teeth, and ear – ''infection'' (particularly with Staph aureus, fungus) is leading cause of ''cavernous sinus thrombosis, and cavernous sinus thrombosis is most common cerebral venous thrombosis''.
*:*:*:* Near oculomotor nerve, ophthalmic nerve, trigeminal nerve, abducens nerve, carotid artery and its surrounding sympathetic plexus.
===Pathogenesis===
* ''Cerebral venous thrombosis usually leads to parenchymal infarction'', though simple [[intracranial hypertension]] may be the only finding.
*:* Venous infarction affects both the cortex and adjacent [[white matter]], and are often hemorrhagic.
*:*:* Association with [[subarachnoid hemorrhage]], [[subdural hemorrhage]], [[intracerebral hematoma]]
*:*:* Classic presentation is ''extensive bilateral hemorrhagic infarcts'' in both superior and internal parts of both hemispheres due to thrombosis of the [[superior sagital sinus]] and its cortical veins.
* Incidence is unknown, but is generally uncommon, ~0.08% of autopsies in one study.
* Pathogenetic factors:
*:* Venous stasis
*:* Hypercoagulability
*:* Vessel wall changes
*:* Embolization
== References ==
{{Reflist|2}}
{{WikiDoc Help Menu}}
{{WS}}
{{WS}}


Revision as of 20:49, 20 June 2018


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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

Pathophysiology

The cavernous sinus which is a true dural venous sinus, is irregularly shaped, trabeculated cavities in the base of the skull.

The cavernous sinus receives blood via the superior and inferior ophthalmic veins through the:

  • Superior orbital fissure
  • Superficial cortical veins

Cavernous sinus is connected to the basilar plexus of veins posteriorly.

There are some important nerves and arteries pass through the cavernous sinus, include:

  • The internal carotid artery (carotid siphon)
  • Cranial nerve III
  • Cranial nerve IV
  • Cranial nerve V branches:
    • Branch V1
    • Branch V2
  • Cranial nerve VII

Infection from the face may reach the cavernous sinus through its many anastomotic connections, with severe consequences. The cavernous sinus drains by two larger channels, the superior and inferior petrosal sinuses, ultimately into the internal jugular vein via the sigmoid sinus, also draining with emissary vein to pterygoid plexus. These sinuses are just lateral and superior to the sphenoid sinus and are immediately posterior to the optic chiasm. Each cavernous sinus is formed between layers of the dura mater, and multiple connections exist between the 2 sinuses.

Pathogenesis

  • It is understood that the main cause of cavernous sinus thrombosis is bacterial infections.
    • Staphylococcus aureus may account for two-thirds of cases of cavernous sinus thrombosis.
    • Other typical organisms include:
      • Streptococcus species (approximately 20% of cases)
      • Pneumococcus (5%)
      • Gram-negative species such as Proteus
      • Hemophilus
      • Pseudomonas
      • Fusobacterium
      • Bacteroides
      • Gram-positive species such as Corynebacterium and Actinomyces
  • In cavernous sinus thrombosis, a blood clot develops in the sinus cavernous structure to prevent the infection from spreading to brain, but it often blocks the blood flow out of the brain.
  • Septic cases of cavernous sinus thrombosis are usually caused by central facial infections, especially within the danger triangle of the face (from the corners of the mouth to the bridge of the nose.
  • The main sources of infection include:
    • Mastoiditis
    • Otitis media
    • Abscess
    • Cellulitis
    • Sinusitis
    • Dental infections or procedures (even a posterior superior alveolar nerve block entering the pterygoid plexus)
    • Maxillofacial surgery
  • The other rare causes of cavernous sinus thrombosis include:
    • Fungal infections
    • Severe head injuries
    • Autoimmune conditions such as lupus
    • Pregnancy

Associated Conditions

References

Template:WH Template:WS

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