Cavernous Sinus Thrombosis

The cavernous sinus thrombosis is a very rare, typically septic cavernous sinus thrombosis, which is usually caused by a Nasenfurunkel or a bacterial sinusitis. Symptoms and clinical signs include pain, proptosis, ophthalmoplegia, loss of vision, papilledema, and fever. The diagnosis can be confirmed by CT or MRI. Treatment is with i.v. Antibiotics. Complications are common, and the prognosis is poor.

The cavernous sinus thrombosis is a very rare, typically septic cavernous sinus thrombosis, which is usually caused by a Nasenfurunkel or a bacterial sinusitis. Symptoms and clinical signs include pain, proptosis, ophthalmoplegia, loss of vision, papilledema, and fever. The diagnosis can be confirmed by CT or MRI. Treatment is with i.v. Antibiotics. Complications are common, and the prognosis is poor. The etiology cavernous sinuses are trabecular sinus in the skull base, in which the venous blood from the facial veins collects. The cavernous sinus thrombosis is an extremely rare complication of facial infections, such as especially Nasenfurunkel (50%), or sphenoid sinusitis ethmoidalis (30%), and dental infections (10%). The most common pathogen is Staphylococcus aureus (70%), followed by Streptococcussp .; Anaerobic bacteria are often if dental or sinus infections underlie. Thrombosis of the lateral sinus (associated with mastoiditis) and thrombosis of the superior sagittal sinus come also exists (in connection with bacterial meningitis) but are less common than cavernous sinus thrombosis. The pathophysiology III., IV., And VI. Cranial nerve and the eye and Oberkieferast of the fifth cranial nerve adjacent to the cavernous sinus and are commonly affected. Complications include encephalitis, brain abscess, stroke, blindness and hypopituitarism. Symptoms and signs Initial symptoms are increasingly stronger head or facial pain, which usually occur unilaterally and are localized in the retrobulbar and forehead. High fever is common. Ophthalmoplegia (typically the VI. Cranial nerve in the early stages), exophthalmos and eyelid edema develop later and are often bilateral. The sensitivity in the face area may be reduced or absent. Depressed consciousness, confusion, seizures and focal neurological deficits are signs of a spread of the infection into the central nervous system. Patients may also have a anisocoria or mydriasis (disturbance of III. Cranial nerve), papilledema, and a loss of vision. Diagnosis MRI or CT The cavernous sinus thrombosis is often misdiagnosed because it is rare. It should be a differential diagnosis considered in patients showing symptoms of an orbital cellulitis. Typical characteristics that distinguish a cavernous sinus thrombosis of an orbital cellulitis include cranial nerve disorders, bilateral eyes findings and changes in consciousness. The diagnosis is based on neuroradiological imaging. MRI is better digestion, but also a cCT can be helpful. Sensible additional tests may include blood cultures and lumbar punctures. Prognosis The overall mortality is 30%, and in patients with underlying sphenoid sinusitis 50%. In an additional 30% of cases, serious complications (eg. As ophthalmoplegia, blindness, disability caused by stroke, hypopituitarism), which may be consistently develop. Iv treatment Some high-dose corticosteroids antibiotics Initial antibiotics are nafcillin and oxacillin 1-2 g every 4-6 h, in combination with a 3rd generation cephalosporin (e.g., ceftriaxone B. 1 g every 12 h). In areas where methicillin-resistant S. aureus is common, vancomycin 1 g iv should every 12 hours are put in the place of or nafcillin oxacillin. A drug against anaerobes (z. B. metronidazole 500 mg every 8 hours) should be given in addition when a sinusitis or a tooth infection. In the case of a sphenoid sinusitis a surgical sinus drainage is required, especially if not within 24 h, a response takes place to the antibiotics. In cranial nerve involvement, the treatment may include corticosteroids (such as dexamethasone 10 mg p.o. every 6 h.); treatment with anticoagulants is controversial because most patients respond to antibiotic therapy and the side effects of anticoagulants may be greater than their benefits.

Health Life Media Team

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