Cavernous sinus thrombosis physical examination

Cavernous sinus thrombosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cavernous sinus thrombosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Cavernous sinus thrombosis physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Cavernous sinus thrombosis physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Cavernous sinus thrombosis physical examination
CDC on Cavernous sinus thrombosis physical examination
Cavernous sinus thrombosis physical examination in the news
Blogs on Cavernous sinus thrombosis physical examination
Directions to Hospitals Treating Psoriasis
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]

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.