CAVERNOUS SINUS THROMBOSIS

Cavernous sinus thrombosis, as its name states, is the formation of a blood clot (thrombus) in the cavernous sinus. The cavernous sinus is located within the skull and serves to drain blood from the brain and the middle portion of the face back to the heart. Surrounding the cavernous sinus are important nerves called the cranial nerves. It is important to know this because cavernous sinus thrombosis affects cranial nerves III, IV, and VI, which are necessary for eye movement, and cranial nerve V, which gives sensation to the top and middle portion of the head and face.

Cavernous sinus thrombosis is rare. Bacterial infections caused by Streptococcus and Staphylococcus are the most common organisms found in patients with cavernous sinus thrombosis. Before antibiotics were discovered, the mortality from cavernous sinus thrombosis was 80% to 100%. Since the discovery of antibiotics, the mortality ranges between 20% and 30%.

Cavernous sinus thrombosis is not contagious and is not inherited. The cause is usually an infection starting in the face, sinus, or ears; as the bloodstream drains back into the cavernous sinus in the skull, the infection spreads to this area and results in the disease.

Infections of the sinus (specifically the sphenoid sinus), eyes, eyelids, ears, or skin of the face can all lead to cavernous sinus thrombosis. The most common scenario is an infection of the sphenoid sinus that lies just below the cavernous sinus, allowing for easy spread of the bacteria. Patients complain of a decrease or loss of vision, a droopy eyelid, bulging eyeballs, and the sudden inability to move the eye in a certain direction. Fever, headaches, rapid heart rate, and stiff neck can all be associated with cavernous sinus thrombosis.

To detect cavernous sinus thrombosis, your doctor will order certain blood tests to identify that an infection is present. A plain radiograph (x-ray) of the sinuses can be helpful to diagnose sinusitis, but a computed tomography (CT) scan may be needed to give more information about an infection of the sphenoid sinus. To best detect cavernous sinus thrombosis, a magnetic resonance imaging (MRI) of the brain can be ordered.

Sometimes a lumbar puncture (placing a needle in the lower back to retrieve fluid surrounding the spinal cord) will be done to rule out the possibility of meningitis.

Once the diagnosis of cavernous sinus thrombosis is established, intravenous antibiotics are administered to treat the infection. Commonly used antibiotics include the penicillins, the cephalosporins, and metronidazole. You may also be placed on a blood thinner called heparin, but this remains controversial and the decision is made between you and your physician.

Surgical drainage of an infected sphenoid sinus is recommended when this is the cause of cavernous sinus thrombosis.

• The best treatment is prevention. Recognizing that the primary source of the disease is infection of the face, middle ear, or sinus and treating this primary source expeditiously is the best way to prevent cavernous sinus thrombosis.
• Understand that cavernous sinus thrombosis can be a life-threatening, rapidly progressive, infectious disease with high mortality rates despite antibiotic use.

• Don't forget that cavernous sinus thrombosis is a medical emergency and, depending on the location of the primary infection, the appropriate specialist should be involved. For example, if the infection is in the eye, an ophthalmologist (a surgeon who specializes in diseases of the eye) should be consulted.
• Don't ignore symptoms suggesting infections of the face, eye, ears, and sinuses.

• If you have any eye pain.
• If you have loss of vision or difficulty with vision.
• If you have fever, headache, nausea, vomiting, and a stiff neck.
• If you have ear pain, hearing loss, or drainage from the ear.
• If you have drainage from the sinus of yellow, green, or blood-tinged mucous.
• If you notice bulging in the eye or droopy eyelids.
• If you cannot move the eye in a certain direction.

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