Disease Information for Cavernous sinus thrombosis: Definition

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  • Formation of a blood clot composed of platelets and fibrin in the CAVERNOUS SINUS of the brain; Infections of the paranasal sinuses and adjacent structures, CRANIOCEREBRAL TRAUMA, and THROMBOPHILIA are associated conditions; Clinical manifestations include dysfunction of cranial nerves III, IV, V, and VI, marked periorbital swelling, chemosis, fever, and visual loss; (From Adams et al, Principles of Neurology, 6th ed)---------------------------------Cavernous Sinus Thrombosis: Cavernous sinus thrombosis is an uncommon diagnosis usually stemming from infections of the face or paranasal sinuses resulting in thrombosis of the cavernous sinus and inflammation of its surrounding anatomic structures,including cranial nerves III, IV, V (ophthalmic and maxillary branch), and VI, and the internal carotid artery; also: intracranial venous sinus thrombosis or thrombophlebitis; Cavernous sinus thrombosis is rare; Before antibiotics the mortality rate from cavernous sinus thrombosis was 80% to 100%; With antibiotics, the mortality rates range between 20% and 30%; Morbidity remains high (between 25% and 50%); Classic findings include: Ptosis; Proptosis; Chemosis; Cranial nerve palsies (III, IV, V, VI); Sixth nerve palsy is the most common; Sensory deficits of the ophthalmic and maxillary branch of the fifth nerve are common; Decreased visual acuity and blindness may occur; Venous engorgement and papilledema on funduscopic examination; Fever, tachycardia, sepsis ; Headache; nuchal rigidity; Pupil may be dilated and sluggishly reactive; Staphylococcus aureus 50% to 60% of the cases; Streptococcus is the second leading cause; Gram-negative rods and anaerobes may also lead to cavernous sinus thrombosis; The most common primary site of infection is sphenoid sinusitis, middle ear, orbit, eye, eyelid, and face; The diagnosis of cavernous sinus thrombosis is made clinically:

    Proptosis, ptosis, chemosis, and cranial nerve palsy beginning in one eye and progressing to the other eye establish the diagnosis; DDX: Orbital cellulites; Internal carotid artery aneurysm; CVA; Migraine headache; Allergic blepharitis; Thyroid exophthalmos; Brain tumor ; Meningitis; Mucormycosis; Trauma; midline lethal granuloma; Wegeners

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