Cavernous Sinus Thrombosis

Cavernous Sinus Thrombosis Definition

A thrombosis in cavernous sinus is a blood clot present within the cavernous sinus. The clot tends to arise with a spread of bacteria from other body parts communicating with the sinus. The most common cause of cavernous thrombosis is infection from facial region, paranasal sinuses and dental complications. It is a life threatening condition requiring immediate medical intervention.

Cavernous Sinus Location

Cavernous sinus is a collection of veins located inside the cranial cavity of the skull. These veins have very thin walls.  The cavity is located at the midline(middle of the skull) and its borders are formed by the temporal and sphenoid bones of the skull.

Cavernous Sinus Thrombosis Symptoms

Generally the patient presents with an untreated mid face infection such as an abscess or acute sinusitis within past two weeks. Early signs of cavernous thrombosis can include headaches, facial swelling with edematous involvement of the eyelids and pain in the eyes. Visual disturbances may also be experienced as the diseases spreads towards the orbit of the eye.

In few cases bleeding from the nose may be experienced. The headaches are sharp shooting and severe in nature accompanied by fever and nausea. As the sinus lies proximal to few cranial nerves, neurological disturbances may be experienced. This may lead to symptoms such as dilation of pupil, photophobia with watering eye and paralysis of muscles of the eye.

Late symptoms include spreading of the infection to other side of the cavernous sinus leading to presence of signs and symptoms on both sides of the face. In advanced stages signs point at meningitis. Dizziness, confusion and delirium are experienced in advanced stages and if left untreated it can lead to coma and eventual death.

Cavernous Sinus Thrombosis Causes

The main cause of cavernous thrombosis is spread of infection form facial region. The infections are generally originated by bacteria such as Staphylococcus aureus and Streptococci pneumoniae. Generally the infection is a large skin boil (furuncle) at the middle third of the face. Infections involving maxillary sinus, maxillary teeth, tonsils, ear and eye can also lead to cavernous sinus thrombosis.

There are two routes by which infection may reach the sinus.

  1. External route involves facial and nasofrontal veins that communicate with cavernous sinus. Therefore the area below the nose and above the upper lip is termed as ‘danger area ‘of the face.
  2. The internal route for spread of the infection involves pterigoid plexus and is generally related to dental infections.

Cavernous Sinus Thrombosis Treatment

With aggressive antibiotic therapy, death associated with cavernous sinus thrombosis is significantly reduced. Antibiotics include chloramphenicol, penicillinase-resistant penicillin and higher generation cephalosporins.If the underlying infection is of dental origin use of metronidazole is recommended. The antibiotics are given for a period of 20 to 30 days.

The most important aspect of treatment is treating the primary source of infection such as facial infection or sinusitis. Incision and drainage can be performed for facial swellings. Use of heparin to prevent the extension of the blood clot and use of steroids such as dexamethasone can be considered in few cases. Mannitol is administered to reduce the edema. In patients unresponsive to medicinal therapy surgical treatment is considered. Sphenoidotomy is performed in suspected sphenoid sinus infections.

Posted by in Head and Neck

Leave a Reply