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Cavernous Sinus Thrombosis


James Garrity

, MD, Mayo Clinic College of Medicine and Science

Last full review/revision Aug 2021

Cavernous sinus thrombosis is a very rare disorder in which a blood clot (thrombosis) forms in the cavernous sinus (a large vein at the base of the skull).

  • Cavernous sinus thrombosis is usually caused by the spread of bacteria from infections of the face and orbit (including the skin of the nose), orbit, or sinus.

  • Symptoms include head and facial pain, visual disturbances, rapidly bulging eyes, and high fever.

  • The diagnosis is based on symptoms and the results of magnetic resonance imaging or computed tomography.

  • Even with treatment, the disorder can result in severe after-effects or be fatal.

  • High doses of antibiotics are given to eliminate the infection.

The cavernous sinus is a large vein at the base of the skull, behind the eyes. This vein drains blood from veins in the face. The cavernous sinus is not one of the air-filled sinuses around the nose (the nasal sinuses).

Causes of Cavernous Sinus Thrombosis

Cavernous sinus thrombosis is usually caused by the spread of bacteria (usually Staphylococcus aureus) from a facial, dental, or nasal sinus infection. CST can be caused by common facial infections such as small nasal boils around hair follicles (furuncles), orbital cellulitis Orbital Cellulitis Orbital cellulitis is infection affecting the tissue within the orbit and around and behind the eye. Infection can spread to the orbit from sources such as the sinuses around the nose. Symptoms... read more Orbital Cellulitis , or sinusitis Sinusitis Sinusitis is inflammation of the sinuses, most commonly caused by a viral or bacterial infection or by an allergy. Some of the most common symptoms of sinusitis are pain, tenderness, nasal congestion... read more of the sphenoid or ethmoid sinuses. Because CST is a possible complication, doctors always consider infections in the area around the nose to the rims of the eyes serious.

Symptoms of Cavernous Sinus Thrombosis

Cavernous sinus thrombosis causes symptoms such as abnormally bulging eyes (proptosis Eyes, Bulging Bulging or protruding of one or both eyes is called proptosis or exophthalmos. Exophthalmos is usually used when describing bulging eyes caused by Graves disease, a disorder causing overactivity... read more Eyes, Bulging ) that occurs over days, swelling of the eyelid, severe headache, facial pain or numbness, impaired eye movements (ophthalmoplegia) with double vision, loss of vision, drowsiness, a high fever, and excessively dilated or uneven pupils. If bacteria spread to the brain, more severe drowsiness, seizures, coma, and abnormal sensations or muscle weakness in certain areas may develop.

Diagnosis of Cavernous Sinus Thrombosis

Prognosis of Cavernous Sinus Thrombosis

Even with antibiotic treatment, cavernous sinus thrombosis can still be life threatening. About 15 to 20% of all affected people die. Another 40% develop serious after-effects (such as impaired eye movements and double vision, blindness, disability due to stroke, and hypopopituitarism), which may be permanent.

Treatment of Cavernous Sinus Thrombosis

  • Antibiotics by vein

  • Surgery to drain infection

  • Corticosteroids and other supplemental hormones

High doses of antibiotics given by vein (intravenously) are started immediately in people with cavernous sinus thrombosis. The infected nasal sinus may be drained surgically, particularly if the person does not improve after 24 hours of antibiotic treatment. Corticosteroids are sometimes given if the cranial nerves are affected. Corticosteroids and usually other supplemental hormones are given if there is hypopituitarism.

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