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Cavernous sinus thrombosis

ბოლო მიმოხილვა: 20 Aug 2025
ბოლო განახლება: 09 Sep 2025

შეჯამება

განსაზღვრება

ანამნეზი და გასინჯვა

ძირითადი დიაგნოსტიკური ფაქტორები

  • rapid onset of signs and symptoms (acute septic cavernous sinus thrombosis)
  • headache
  • fever
  • periorbital edema
  • chemosis and proptosis
  • lateral gaze palsy
  • ophthalmoplegia
  • profound sepsis (acute septic cavernous sinus thrombosis [CST])
სრული ტექსტი

სხვა დიაგნოსტიკური ფაქტორები

  • ptosis and mydriasis
  • papilledema and/or retinal-vein dilatation
  • decreased corneal reflex
  • hypo- or hyperesthesia 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 or Brudzinski signs
  • seizures
  • loss of visual acuity
სრული ტექსტი

რისკფაქტორები

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

დიაგნოსტიკური კვლევები

1-ად შესაკვეთი გამოკვლევები

  • CBC
  • 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 anticardiolipin antibodies
  • protein S and protein C
  • antithrombin III
  • factor V Leiden
  • hemoglobin electrophoresis
  • D-dimer level
სრული ტექსტი

გასათვალისწინებელი კვლევები

  • lumbar puncture with cerebrospinal fluid analysis
სრული ტექსტი

მკურნალობის ალგორითმი

საწყისი

suspected cavernous sinus thrombosis (CST)

მწვავე

confirmed septic cavernous sinus thrombosis (CST): without hemorrhagic complications

confirmed septic cavernous sinus thrombosis (CST): with hemorrhagic complications

confirmed aseptic cavernous sinus thrombosis (CST): without hemorrhagic complications

confirmed aseptic cavernous sinus thrombosis (CST): with hemorrhagic complications

კონტრიბუტორები

ავტორები

Jayant Pinto, MD

Associate Professor of Surgery

Section of Otolaryngology-Head and Neck Surgery

University of Chicago

IL

გაფრთხილება:

JMP has received funds from Regeneron, Sanofi, and Optinose for speaker's bureau and advisory boards. He served as a site investigator for Regeneron, Sanofi, and Upstream Bio.

Mohamad R. Chaaban, MD, MSCR, MBA

Associate Professor

Cleveland Clinic

Lerner College of Medicine at Case Western Reserve University

Cleveland

OH

გაფრთხილება:

MRC has no competing interests.

რეცენზენტები

David Rowed, MD

Division of Neurosurgery

University of Toronto

Toronto

Ontario

Canada

გაფრთხილება:

DR declares that he has no competing interests.

Louis R. Caplan, MD

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston

MA

Divulgaciones

LRC declares that he has no competing interests.

Sorabh Khandelwal, MD

Clinical Associate Professor of Emergency Medicine

Ohio State University

Columbus

OH

Divulgaciones

SK declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Ebright JR, Pace MT, Niazi AF. Septic thrombosis of the cavernous sinuses. Arch Intern Med. 2001 Dec 10-24;161(22):2671-6.Texto completo  Resumen

Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: a review. Surv Ophthalmol. 2021 Nov-Dec;66(6):1021-30. Resumen

Bhatia K, Jones NS. Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature. J Laryngol Otol. 2002 Sep;116(9):667-76. Resumen

American College of Radiology. ACR appropriateness criteria: headache. 2022 [internet publication].Texto completo

American College of Radiology. ACR appropriateness criteria: orbits, vision, and visual loss. 2017 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Cavernous sinus thrombosis images
  • Diferenciales

    • Periorbital or orbital cellulitis
    • Superior orbital fissure syndrome
    • Orbital apex syndrome
    Más Diferenciales
  • Guías de práctica clínica

    • ACR appropriateness criteria: cerebrovascular diseases-stroke and stroke-related conditions
    • ACR appropriateness criteria: headache
    Más Guías de práctica clínica
  • Folletos para el paciente

    Meningitis and septicemia

    Preventing another stroke

    Más Folletos para el paciente
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