Cavernous sinus thrombosis (CST)

1. Causes
a. Sinusitis
b. Orbital cellitis
c. Infection of facial vein through dangerous triangle
Thrombophlebitis of facial vein
d. Less common: bacteremia, trauma, infection of ear/maxillary
teeth
2. Physical findings:
Early: unilateral, may become bilateral at later stage
a. Opthalophlegia (CN III, IV, VI)
b. Chemosis (swelling of conjunctiva)
c. Visual loss
d. Numbness of frontal/malar region (CN V1, V2)
3. Differential diagnosis
a. Meningitis
b. Brain tumor
c. Sinusitis, orbital infection
d. Epidural/subdrual hematoma, subarachnoid hemorrhage
4. Investigation:
a. Lumbar puncture: exclude meningitis
b. Blood culture/ sinus culture: identified infectious sources
c. Contrasted CT scan: reveal sinusitis, contrast filling-defected
in cavernous sinus
d. MRI: Deformity of ICA within cavernous sinus, thrombosed
vascular sinuses
5. Treatment
a. Treat primary infection
b. Broad-spectrum IV antibiotics
6. Prognosis
a. With antibiotics, mortality rate drops from 100% to 30%
b. 1/6: visual impairment, 1/5: cranial nerve deficits