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, fever, Proptosis, Chemosis, external ophthalmoplegia, periorbital swelling and redness in one or both eyes. Other symptoms of cavernous sinus thrombosis include: Drooping eyelids, Decreased visual acuity, Vision loss or double vision, Inability to move the eye, periorbital sensory loss, pain or numbness around the face or eyes, fatigue, Seizures and Lethargy. Common complications of cavernous sinus thrombosis include: Death, bilateral blindness, Seizures, total ophthalmoplegia, Anisocoria, Meningitis, Intracerebral hemorrhage, Facial palsy, Hemiparesis, venous infarction, Ptosis and Hypopituitarism. 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 include: Rapid progression, Coma, extremes of age, focal signs and symptoms, Hemorrhagic infarct and 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 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 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.
↑ ^3.0 ^3.1 ^3.2 ^3.3 ^3.4 ^3.5 ^3.6 ^3.7 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 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.
↑ 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.
↑ 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 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.
↑ 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.
↑ 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.
↑ 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 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.
↑ Rodrigues R, Merchant R, Parekh S (1983). "Cavernous sinus thrombosis with retrobulbar mass and hemiplegia". Indian J Pediatr. 50 (405): 457–9. PMID 6671735.
↑ 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.
↑ 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 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 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] 3.0 ^3.1 ^3.2 ^3.3 ^3.4 ^3.5 ^3.6 ^3.7 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 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] 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] 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 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] 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] 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] 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 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] 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] 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] Silver HS, Morris LR (1983). "Hypopituitarism secondary to cavernous sinus thrombosis". South Med J. 76 (5): 642–6. PMID 6302919.

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