Cavernous sinus thrombosis differential diagnosis

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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]

Differentiating cavernous sinus thrombosis] from other Diseases

Cavernous sinus thrombosis must be differentiated from other diseases that cause severe headache, pain with eye movements, high fever, proptosis, periorbital swelling, and ophthalmoplegia, such as orbital cellulitis, acute Angle-Closure Glaucoma, intracranial tumors and, carotid cavernous fistula and tolosa-Hunt syndrome.

Diseases	Clinical manifestations						Para-clinical findings			Additional findings
	Symptoms			Physical examination
							Lab Findings
	Severe headache	High fever	Pain with eye movements	Proptosis	Periorbital swelling and redness in one or both eyes	Ophthalmoplegia	Elevated ESR and CRP	Positive blood culture[	Neutrophilic-predominant leukocytosis
Cavernous sinus thrombosis	++	++	++	++	++	++	++	++	++
Orbital cellulitis	+	+	+++	+++	+++	++	++	+	+	It may be acute or chronic. May also occur after trauma. May lead to cavernous sinus thrombosis.
Acute Angle-Closure Glaucoma	+++	_	++	+	++	_/+	_	_	_	Nausea and vomiting and Profuse tearing are prominent Haloes around lights may be seen
Tumors such as: Metastatic cancer Meningioma Schwannoma Plexiform neurofibroma Pituitary adenoma Chordoma Chondrosarcoma Melanocytoma Nasopharyngeal carcinoma	+	_	_/+	_/+	_	++	_/+	_	_/+	In most cases of intracranial tumors the symptoms progression is not fast.
Lytic bone lesions near the sphenoid sinus or sella turcica	+	_	_	_	_	++	_	_	_	Slow progression in most cases
Carotid cavernous fistula	+	_	+	+	_/+	_/+	_	_	_	Patients usually present with sudden or insidious onset of redness in one eye, associated with progressive proptosis or bulging Bruit (a humming sound within the skull due to high blood flow through the arteriovenous fistula) may be heard
Cavernous hemangioma	+	_	+	+	+	_/+	_	_	_	Cavernous hemangioma is found in women more frequently than men, most commonly between the ages of 20-40
Tolosa-Hunt syndrome	+	_	+	_/+	_	+	_	_	_/+	Symptoms are usually limited to one side of the head, and in most cases the individual affected will experience intense, sharp pain and paralysis of muscles around the eye