Last reviewed:October 2019
Last updated:November  2019

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 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
  • history of malignancy
  • history 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
Full details

Treatment algorithm

Contributors

Associate Professor of Surgery

Section of Otolaryngology-Head and Neck Surgery

University of Chicago

IL

Disclosures

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.

Associate Professor

Department of Otolaryngology

University of Texas Medical Branch

TX

Disclosures

MC declares that he has no competing interests.

Peer reviewersVIEW 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.

Use of this content is subject to our disclaimer