Cavernous sinus thrombosis natural history, complications and prognosis

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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

The symptoms of cavernous sinus thrombosis may vary depend on the anatomical structures involved.

The most common symptoms of cavernous sinus thrombosis include:
- Severe holocranial and bifrontal headache whit increasing severity^[1]^[2]^[3]
- Fever^[1]^[2]^[3]
- Proptosis^[1]
- Chemosis^[1]
- External ophthalmoplegia^[1]^[3]
- Periorbital swelling and redness in one or both eyes^[1]^[3]

Other symptoms of cavernous sinus thrombosis include:
- Drooping eyelids^[1]^[3]
- Decreased visual acuity^[1]^[3]
- Vision loss or double vision^[3]
- Inability to move the eye^[3]
- Periorbital sensory loss^[1]
- Pain or numbness around the face or eyes^[1]
- Fatigue^[1]
- Seizures^[4]
- Lethargy^[1]

Complications

Common complications of cavernous sinus thrombosis include:
- Death^[5]
- Bilateral blindness^[6]
- Seizures^[4]
- Total ophthalmoplegia^[7]
- Anisocoria^[7]
- Meningitis^[8]
- Intracerebral hemorrhage^[9]
- Facial palsy^[10]
- Hemiparesis^[11]^[12]
- Venous infarction^[11]
- Ptosis^[13]
- Hypopituitarism^[14]

Prognosis

Prognosis better as diagnosis is increasing made with imaging instead of autopsy, with mortality rates down from 100% to 6.5% in a recent review of 76 patients.
Poor prognostic features:
- Rapid progression
- Coma
- Extremes of age
- Focal signs and symptoms
- Hemorrhagic infarct
- Serious underlying cause

Natural History, Complications, and Prognosis

Natural History

The symptoms of cavernous sinus thrombosis may vary depend on the anatomical structures involved.^[1]

The most common symptoms of cavernous sinus thrombosis include:
- Severe holocranial and bifrontal headache whit increasing severity^[1]^[2]^[3]
- Fever^[1]^[2]^[3]
- Proptosis^[1]
- Chemosis^[1]
- External ophthalmoplegia^[1]^[3]
- Periorbital swelling and redness in one or both eyes^[1]^[3]

Other symptoms of cavernous sinus thrombosis include:
- Drooping eyelids^[1]^[3]
- Decreased visual acuity^[1]^[3]
- Vision loss or double vision^[3]
- Inability to move the eye^[3]
- Periorbital sensory loss^[1]
- Pain or numbness around the face or eyes^[1]
- Fatigue^[1]
- Seizures^[4]
- Lethargy^[1]

Complications

Common complications of cavernous sinus thrombosis include:
- Death^[5]
- Bilateral blindness^[6]
- Seizures^[4]
- Total ophthalmoplegia^[7]
- Anisocoria^[7]
- Meningitis^[8]
- Intracerebral hemorrhage^[9]
- Facial palsy^[10]
- Hemiparesis^[11]^[12]
- Venous infarction^[11]
- Ptosis^[13]
- Hypopituitarism^[14]

Prognosis

Prognosis better as diagnosis is increasing made with imaging instead of autopsy, with mortality rates down from 100% to 6.5% in a recent review of 76 patients.
Poor prognostic features:
- Rapid progression
- Coma
- Extremes of age
- Focal signs and symptoms
- Hemorrhagic infarct
- Serious underlying cause
Of note, if patient survives, outcome is better than for arterial infarct

References

↑ ^1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 ^1.21 ^1.22 ^1.23 ^1.24 Yeo GS, Kim HY, Kim H, Kwak EJ, Jung YS, Park HS; et al. (2014). "Cavernous sinus thrombosis caused by a dental infection: a case report". J Korean Assoc Oral Maxillofac Surg. 40 (4): 195–8. doi:10.5125/jkaoms.2014.40.4.195. PMC 4170663. PMID 25247150.
↑ ^2.0 ^2.1 ^2.2 ^2.3 Botta R, Donirpathi S, Yadav R, Kulkarni GB, Kumar MV, Nagaraja D (2017). "Headache Patterns in Cerebral Venous Sinus Thrombosis". J Neurosci Rural Pract. 8 (Suppl 1): S72–S77. doi:10.4103/jnrp.jnrp_339_16. PMC 5602266. PMID 28936075.
↑ ^3.00 ^3.01 ^3.02 ^3.03 ^3.04 ^3.05 ^3.06 ^3.07 ^3.08 ^3.09 ^3.10 ^3.11 ^3.12 ^3.13 ^3.14 ^3.15 Mallick A, Pathak SD, Shankar S, Sati A (2015). "Early cavernous sinus thrombosis following unilateral pansinusitis in a child". BMJ Case Rep. 2015. doi:10.1136/bcr-2014-208441. PMC 4422932. PMID 25917067.
↑ ^4.0 ^4.1 ^4.2 ^4.3 Sha DJ, Qian J, Gu SS, Wang LN, Wang F, Xu Y (2018). "Cerebral venous sinus thrombosis complicated by seizures: a retrospective analysis of 69 cases". J Thromb Thrombolysis. 45 (1): 186–191. doi:10.1007/s11239-017-1570-5. PMC 5756278. PMID 29039017.
↑ ^5.0 ^5.1 Clifford-Jones RE, Ellis CJ, Stevens JM, Turner A (1982). "Cavernous sinus thrombosis". J Neurol Neurosurg Psychiatry. 45 (12): 1092–7. PMC 491689. PMID 7161604.
↑ ^6.0 ^6.1 Coutteel C, Leys A, Fossion E, Missotten L (1991). "Bilateral blindness in cavernous sinus thrombosis". Int Ophthalmol. 15 (3): 163–71. PMID 2050471.
↑ ^7.0 ^7.1 ^7.2 ^7.3 Bouraoui R, Bouladi M, Ben Romdhane B, Limaiem R, Mghaieth F, El Matri L (2016). "Ophthalmic artery occlusion with total ophtalmoplegia and anisocoria revealing cavernous sinus thrombosis". Tunis Med. 94 (2): 145–7. PMID 27532532.
↑ ^8.0 ^8.1 Munckhof WJ, Krishnan A, Kruger P, Looke D (2008). "Cavernous sinus thrombosis and meningitis from community-acquired methicillin-resistant Staphylococcus aureus infection". Intern Med J. 38 (4): 283–7. doi:10.1111/j.1445-5994.2008.01650.x. PMID 18380704.
↑ ^9.0 ^9.1 Pongmoragot J, Saposnik G (2012). "Intracerebral hemorrhage from cerebral venous thrombosis". Curr Atheroscler Rep. 14 (4): 382–9. doi:10.1007/s11883-012-0260-1. PMID 22664979.
↑ ^10.0 ^10.1 Verma R, Junewar V, Singh RK, Ram H, Pal US (2013). "Bilateral cavernous sinus thrombosis and facial palsy as complications of dental abscess". Natl J Maxillofac Surg. 4 (2): 252–5. doi:10.4103/0975-5950.127664. PMC 3961908. PMID 24665189.
↑ ^11.0 ^11.1 ^11.2 ^11.3 Kamouchi M, Wakugawa Y, Okada Y, Kishikawa K, Matsuo R, Toyoda K; et al. (2006). "Venous infarction secondary to septic cavernous sinus thrombosis". Intern Med. 45 (1): 25–7. PMID 16467601.
↑ ^12.0 ^12.1 Rodrigues R, Merchant R, Parekh S (1983). "Cavernous sinus thrombosis with retrobulbar mass and hemiplegia". Indian J Pediatr. 50 (405): 457–9. PMID 6671735.
↑ ^13.0 ^13.1 Kraus CL, Culican SM (2012). "Challenging presentations of cavernous sinus thrombophlebitis". J Ophthalmic Inflamm Infect. 2 (3): 133–6. doi:10.1007/s12348-011-0053-7. PMC 3438306. PMID 22139823.
↑ ^14.0 ^14.1 Silver HS, Morris LR (1983). "Hypopituitarism secondary to cavernous sinus thrombosis". South Med J. 76 (5): 642–6. PMID 6302919.

Template:WH Template:WS

[pmid25247150-1] 1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 ^1.21 ^1.22 ^1.23 ^1.24 Yeo GS, Kim HY, Kim H, Kwak EJ, Jung YS, Park HS; et al. (2014). "Cavernous sinus thrombosis caused by a dental infection: a case report". J Korean Assoc Oral Maxillofac Surg. 40 (4): 195–8. doi:10.5125/jkaoms.2014.40.4.195. PMC 4170663. PMID 25247150.

[pmid28936075-2] 2.0 ^2.1 ^2.2 ^2.3 Botta R, Donirpathi S, Yadav R, Kulkarni GB, Kumar MV, Nagaraja D (2017). "Headache Patterns in Cerebral Venous Sinus Thrombosis". J Neurosci Rural Pract. 8 (Suppl 1): S72–S77. doi:10.4103/jnrp.jnrp_339_16. PMC 5602266. PMID 28936075.

[pmid25917067-3] 3.00 ^3.01 ^3.02 ^3.03 ^3.04 ^3.05 ^3.06 ^3.07 ^3.08 ^3.09 ^3.10 ^3.11 ^3.12 ^3.13 ^3.14 ^3.15 Mallick A, Pathak SD, Shankar S, Sati A (2015). "Early cavernous sinus thrombosis following unilateral pansinusitis in a child". BMJ Case Rep. 2015. doi:10.1136/bcr-2014-208441. PMC 4422932. PMID 25917067.

[pmid29039017-4] 4.0 ^4.1 ^4.2 ^4.3 Sha DJ, Qian J, Gu SS, Wang LN, Wang F, Xu Y (2018). "Cerebral venous sinus thrombosis complicated by seizures: a retrospective analysis of 69 cases". J Thromb Thrombolysis. 45 (1): 186–191. doi:10.1007/s11239-017-1570-5. PMC 5756278. PMID 29039017.

[pmid7161604-5] 5.0 ^5.1 Clifford-Jones RE, Ellis CJ, Stevens JM, Turner A (1982). "Cavernous sinus thrombosis". J Neurol Neurosurg Psychiatry. 45 (12): 1092–7. PMC 491689. PMID 7161604.

[pmid2050471-6] 6.0 ^6.1 Coutteel C, Leys A, Fossion E, Missotten L (1991). "Bilateral blindness in cavernous sinus thrombosis". Int Ophthalmol. 15 (3): 163–71. PMID 2050471.

[pmid27532532-7] 7.0 ^7.1 ^7.2 ^7.3 Bouraoui R, Bouladi M, Ben Romdhane B, Limaiem R, Mghaieth F, El Matri L (2016). "Ophthalmic artery occlusion with total ophtalmoplegia and anisocoria revealing cavernous sinus thrombosis". Tunis Med. 94 (2): 145–7. PMID 27532532.

[pmid18380704-8] 8.0 ^8.1 Munckhof WJ, Krishnan A, Kruger P, Looke D (2008). "Cavernous sinus thrombosis and meningitis from community-acquired methicillin-resistant Staphylococcus aureus infection". Intern Med J. 38 (4): 283–7. doi:10.1111/j.1445-5994.2008.01650.x. PMID 18380704.

[pmid22664979-9] 9.0 ^9.1 Pongmoragot J, Saposnik G (2012). "Intracerebral hemorrhage from cerebral venous thrombosis". Curr Atheroscler Rep. 14 (4): 382–9. doi:10.1007/s11883-012-0260-1. PMID 22664979.

[pmid24665189-10] 10.0 ^10.1 Verma R, Junewar V, Singh RK, Ram H, Pal US (2013). "Bilateral cavernous sinus thrombosis and facial palsy as complications of dental abscess". Natl J Maxillofac Surg. 4 (2): 252–5. doi:10.4103/0975-5950.127664. PMC 3961908. PMID 24665189.

[pmid16467601-11] 11.0 ^11.1 ^11.2 ^11.3 Kamouchi M, Wakugawa Y, Okada Y, Kishikawa K, Matsuo R, Toyoda K; et al. (2006). "Venous infarction secondary to septic cavernous sinus thrombosis". Intern Med. 45 (1): 25–7. PMID 16467601.

[pmid6671735-12] 12.0 ^12.1 Rodrigues R, Merchant R, Parekh S (1983). "Cavernous sinus thrombosis with retrobulbar mass and hemiplegia". Indian J Pediatr. 50 (405): 457–9. PMID 6671735.

[pmid22139823-13] 13.0 ^13.1 Kraus CL, Culican SM (2012). "Challenging presentations of cavernous sinus thrombophlebitis". J Ophthalmic Inflamm Infect. 2 (3): 133–6. doi:10.1007/s12348-011-0053-7. PMC 3438306. PMID 22139823.

[pmid6302919-14] 14.0 ^14.1 Silver HS, Morris LR (1983). "Hypopituitarism secondary to cavernous sinus thrombosis". South Med J. 76 (5): 642–6. PMID 6302919.

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Cavernous sinus thrombosis natural history, complications and prognosis

Overview

Complications

Prognosis

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

References

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