Cavernous sinus thrombosis medical therapy

Cavernous sinus thrombosis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

• Antithrombotics

  • Anticoagulation
  • Standard treatment at this time, even if moderate intracranial hemorrhage present
  • Controversial in the past given risk of associated hemorrhage – one small randomized study with 20 patients in each arm showed a significant benefit making anticoagulation standard of care.
  • Thrombolysis – with agents like urokinase, TPA – generally given via microcatheters inserted for local infusion
  • Initial infusion sometimes followed by continuous infusion for a day or more until clot clears.
  • Many case reports of success, but not standard treatment at this time.
  • A study of 9 patients in Korea showed successful thrombolysis in all patients
  • Risk of hemorrhage
  • The literature suggests that it is mostly used now in severe cases with stupor, coma, rapidly progressing course, or severely raised ICP, and only in centers experienced in the methodology. Its role may expand with more experience.
  • Surgical thrombectomy – not generally performed anymore

• Antieleptics – as indicated
• Antibiotics – if infectious precipitant
• Intracranial pressure manipulation

  • Medical: mannitol, steroids, acetazolamide, repeat LPs
  • Shunt

References

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