Cavernous Sinus Thrombosis

Also Know As Venous Sinus Thrombosis

Cavernous sinus thrombosis 

Cavernous sinus thrombosis (CST) is a serious medical condition that involves a blood clot in an anatomical area called cavernous sinus situated at the bottom of the brain. ^[1] With the available medications, mortality was lowered down to 30% however complete healing is uncommon. ^[2] CST can lead to complications such as stroke and blindness. Prompt medical attention is required. ^[1]

Epidemiology

The condition is rare. There are no reported race and gender predilection. Everyone can be affected. Average age of affected individuals is 22 years old. ^[2]

Causes

The typical cause is an infection by a bacteria seeding from other adjacent parts such as the teeth, sinuses and ears. ^[3] In order to contain the infection, the body undergoes adaptive mechanisms, one of which leads to clot formation. However, clot raises pressure inside the brain leading to brain injury. ^[4]
Trauma also has been suggested to cause CST. ^[1] Conditions like chronic sinusitis and diabetes are risk factors. ^[2]

Signs and Symptoms

Headache is very common. The symptoms depend on the structures involved. A patient may manifest with swelling in the areas around the eye accompanied by changes in vision or drooping eyelids. It may occur initially on one eye then later involve the other eye in a span of one to two days. This is due to spreading within the intercavernous sinuses.

A patient may also manifest with neck rigidity and decreased sensation. If there is sepsis, the person may have fever and chills. Since the brain is involved, the individual may develop confusion and fall into coma.  ^[2]

Diagnosis

History often points out to a recent infection. Diagnosis is based on laboratory imaging results such as MRI and CT scan. Lumbar puncture tests and blood cultures are also valuable. ^[5]

Treatment

Central to treatment of CST is prompt high-dose antibiotic administration through intravenous line usually given in a minimum period of three to four weeks. Corticosteroids and blood thinners are at times prescribed. Surgery is infrequently done as it is technically hard although drainage is sometimes indicated. ^[2]

References:

1. http://www.wisegeek.com/what-is-cavernous-sinus-thrombosis.htm
2. http://emedicine.medscape.com/article/791704-overview#a0199
3. http://www.nlm.nih.gov/medlineplus/ency/article/001628.htm
4. http://www.webmd.com/a-to-z-guides/cavernous-sinus-thrombosis
5. http://www.merckmanuals.com/professional/eye_disorders/orbital_diseases/cavernous_sinus_thrombosis.html

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