Cavernous sinus thrombosis physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with cavernous sinus thrombosis is usually remarkable for high fever, 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, retinal hemorrhages, decreased visual acuity, photophobia, diminished pupillary reflex, and pulsating conjunctiva. | 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=== | ||
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*High-grade fever | *High-grade fever | ||
*[[Tachycardia]] with regular pulse | *[[Tachycardia]] with regular pulse | ||
*Tachypnea | *[[Tachypnea]] | ||
*Low blood pressure with normal pulse pressure | *Low blood pressure with normal pulse pressure | ||
=== Skin === | === Skin === | ||
* [[Pallor]] may be present | |||
* [[Pallor]] | |||
===HEENT=== | ===HEENT=== | ||
* Periorbital edema (initially unilateral but typically bilateral) | * [[Periorbital edema]] (initially unilateral but typically bilateral) | ||
* Unilateral or bilateral [[exophthalmos]] | * Unilateral or bilateral [[exophthalmos]] | ||
* Extra-ocular movements may be abnormal from third, fourth and 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 | ||
** Sixth cranial 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). | ||
*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]]) | ||
*Lid erythema | *Lid [[erythema]] | ||
*Horner syndrome (ptosis, miosis, and anhidrosis) | *[[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]]) | ||
*Chemosis | *[[Chemosis]] | ||
*Ptosis | *[[Ptosis]] | ||
*Proptosis (due to impaired venous drainage of orbit) | *[[Proptosis]] (due to impaired venous drainage of [[orbit]]) | ||
*Painful eye movement | *Painful eye movement | ||
*Papilledema | *[[Papilledema]] | ||
*Retinal hemorrhages | *[[Retinal haemorrhage|Retinal hemorrhages]] | ||
*Decreased visual acuity | *Decreased [[visual acuity]] | ||
*Photophobia | *[[Photophobia]] | ||
*Pulsating conjunctiva | *Pulsating [[conjunctiva]] | ||
* Facial tenderness | * Facial tenderness | ||
* Impaired corneal reflex | * Impaired [[corneal reflex]] | ||
* Blindness | * [[Blindness]] | ||
===Neck=== | ===Neck=== | ||
*Stiff neck may be present. | *[[Neck stiffness|Stiff neck]] may be present. | ||
===Lungs=== | ===Lungs=== | ||
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* 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]] | ||
* Extra-ocular movements may be abnormal from third, fourth and 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 | ||
** Sixth cranial 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). | ||
* Photophobia | * [[Photophobia]] | ||
* Horner syndrome (ptosis, miosis, and anhidrosis) | * [[Horner's syndrome|Horner syndrome]] ([[ptosis]], [[miosis]], and [[anhidrosis]]) | ||
* Hyperreflexia | * [[Hyperreflexia]] | ||
* Generalised weakness | * [[Weakness|Generalised weakness]] | ||
*Abnormal gait | *Abnormal [[gait]] | ||
*Decreased visual acuity | *Decreased [[visual acuity]] | ||
*Downgoing plantar reflex | *Downgoing [[plantar reflex]] | ||
*Ptosis | *[[Ptosis]] | ||
*Hemiparesis | *[[Hemiparesis]] | ||
===Extremities=== | ===Extremities=== | ||
Revision as of 15:01, 5 July 2018
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Cavernous sinus thrombosis Microchapters |
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Differentiating Cavernous sinus thrombosis from other Diseases |
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Cavernous sinus thrombosis physical examination On the Web |
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American Roentgen Ray Society Images of Cavernous sinus thrombosis physical examination |
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Risk calculators and risk factors for Cavernous sinus thrombosis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Physical Examination
Physical examination of patients with cavernous sinus thrombosis is usually remarkable for high fever, 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, retinal hemorrhages, decreased visual acuity, photophobia, diminished pupillary reflex, and pulsating conjunctiva.
Appearance of the Patient
- Patients with cavernous sinus thrombosis usually appear very ill and toxic.
Vital Signs
- High-grade fever
- Tachycardia with regular pulse
- Tachypnea
- Low blood pressure with normal pulse pressure
Skin
- Pallor may be present
HEENT
- Periorbital edema (initially unilateral but typically bilateral)
- Unilateral or bilateral exophthalmos
- Extra-ocular movements may be abnormal from third, fourth and sixth cranial neuropathy
- Sixth cranial nerve neuropathy is the most common neuropathy (resulting in partial ophthalmoplegia with limited eye abduction).
- Pupils non-reactive 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
Neck
- Stiff neck may be present.
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
- Extra-ocular movements may be abnormal from third, fourth and sixth cranial neuropathy
- Sixth cranial nerve neuropathy is the most common neuropathy (resulting in partial ophthalmoplegia with limited eye abduction).
- Photophobia
- Horner syndrome (ptosis, miosis, and anhidrosis)
- Hyperreflexia
- Generalised weakness
- Abnormal gait
- Decreased visual acuity
- Downgoing plantar reflex
- Ptosis
- Hemiparesis
Extremities
- Extremities examination of patients with cavernous sinus thrombosis is usually normal.