Summary
Definition
History and exam
Key diagnostic factors
- rapid onset of signs and symptoms (acute septic CST)
- headache
- fever
- periorbital edema
- chemosis and proptosis
- lateral gaze palsy
- ophthalmoplegia
- profound sepsis (acute septic CST)
Other diagnostic factors
- 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
Risk factors
- recent hx of acute sinusitis
- hx of facial infections
- hx of periorbital 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
- 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 anticardiolipid antibodies
- protein S and protein C
- antithrombin III
- factor V Leiden
- hemoglobin electrophoresis
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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