Cavernous sinus thrombosis

Cavernous sinus thrombosis (CST) is a 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.

Must be differentiated from meningitis. Common early clinical features of both conditions include fever, headache, vomiting, and nuchal rigidity.

In the acute presentation, one eye is typically affected first, followed by the second eye within 48 hours of symptom onset.

Diagnosis is usually made through clinical evaluation together with imaging (computed tomography or magnetic resonance imaging).

Antibiotics should be started immediately at the earliest suspicion of CST because they have the greatest effect on prognosis.

CST is the formation of thrombus (clot) within the cavernous sinus: a paired, trabeculated venous channel extending anteriorly from the superior orbital fissure and posteriorly to the petrous portion of the temporal bone. It 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.