Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • rapid onset of signs and symptoms (acute septic CST)
  • headache
  • fever
  • peri-orbital oedema
  • chemosis and proptosis
  • lateral gaze palsy
  • ophthalmoplegia
  • profound sepsis (acute septic CST)

Other diagnostic factors

  • ptosis and mydriasis
  • papilloedema and/or retinal-vein dilatation
  • decreased corneal reflex
  • hypo- or hyper-aesthesia in the distribution of the ophthalmic and maxillary nerves
  • mental state changes (e.g., confusion, drowsiness, coma)
  • clinically detectable primary infection site
  • meningismus (nuchal rigidity, photophobia, and headache)
  • positive Kernig's or Brudzinski's signs
  • seizures
  • loss of visual acuity

Risk factors

  • recent hx of acute sinusitis
  • hx of facial infections
  • hx of peri-orbital infection
  • hx of otitis media, mastoiditis, or petrositis
  • hx of dental or oral infection
  • hx of sepsis
  • immunosuppression
  • genetic prothrombotic condition
  • acquired and other prothrombotic states
  • hx of head and neck trauma
  • use of oral contraceptives
  • hx of malignancy
  • hx of recent head or neck surgery
  • vascular abnormalities
  • ulcerative colitis
  • volume depletion
  • heroin overdose

Diagnostic investigations

1st investigations to order

  • FBC
  • contrast-enhanced high-resolution CT of head
  • contrast-enhanced MRI of head
  • blood culture
  • microscopy and culture of suppurative fluid or tissue from primary infective source
  • antiphospholid and anticardiolipid antibodies
  • protein S and protein C
  • antithrombin III
  • factor V Leiden
  • haemoglobin electrophoresis
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Assistant Professor of Surgery

Section of Otolaryngology-Head and Neck Surgery

University of Chicago

IL

Disclosures

JP declares that he has no competing interests.

Rhinology Fellow

School of Medicine

University of Alabama at Birmingham

AL

Disclosures

MC declares that he has no competing interests.

Peer reviewers VIEW ALL

Division of Neurosurgery

University of Toronto

Toronto

Ontario

Canada

Disclosures

DR declares that he has no competing interests.

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston

MA

Disclosures

LRC declares that he has no competing interests.

Clinical Associate Professor of Emergency Medicine

Ohio State University

Columbus

OH

Disclosures

SK declares that he has no competing interests.

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