Thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic condition.
In the pre-antibiotic era, infections of the middle third of the face were responsible for the majority of cases. Currently, acute sinusitis is the most common predisposing condition.
Diagnosis is usually made through clinical evaluation together with imaging (computed tomography or magnetic resonance imaging).
In the acute presentation, one eye is typically affected first, followed by the second eye within 48 hours of symptom onset.
Must be differentiated from meningitis. Common early clinical features of both conditions include fever, headache, vomiting, and nuchal rigidity.
Antibiotics should be started immediately because they have the greatest effect on prognosis.
Cavernous sinus thrombosis (CST) is the formation of thrombus (clot) within the cavernous sinus, which can either be septic or aseptic. Septic CST is a rapidly evolving thrombophlebitic process with an infectious origin (typically from the middle third of the face, sinuses, ears, teeth, or mouth), affecting the cavernous sinus and its structures. Aseptic CST is usually a thrombotic process that is a result of trauma, iatrogenic injuries, or prothrombotic conditions.
Associate Professor of Surgery
Section of Otolaryngology-Head and Neck Surgery
University of Chicago
JP serves as a speaker and advisor to Optinose and Stallergenes. JP is a member of the advisory board for Genentech and ALK. JP has received grants from the National Institutes of Health.
Department of Otolaryngology
University of Texas Medical Branch
MC declares that he has no competing interests.
Division of Neurosurgery
University of Toronto
DR declares that he has no competing interests.
Lecturer in Neurology
Beth Israel Deaconess Medical Center
Division of Cerebrovascular/Stroke
LRC declares that he has no competing interests.
Clinical Associate Professor of Emergency Medicine
Ohio State University
SK declares that he has no competing interests.
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