In cavernous sinus thrombosis, also known as sinus thrombosis, a blood clot (thrombus) forms in the cavernous sinus. The cavernous sinus is a cavity at the bottom of the brain, in the skull. It helps drain blood from the brain and the middle part of the face back to the heart. Cranial nerves surround the sinus. These nerves are needed for eye movement and feeling at the top and middle parts of the head and face. People of any age, sex, or race can have this condition.
The cause of this rare condition is usually an infection starting in the face (skin), eyes, eyelids, sphenoid sinus, or ears. Most often, infection of the sphenoid sinus, just below the cavernous sinus, lets bacteria spread easily. Infections caused by the bacteria Streptococcus and Staphylococcus are the most common.
Symptoms include reduced vision or loss of vision, drooping eyelid, bulging eyeballs, and suddenly being unable to move the eye in a certain direction. Fever, headaches, rapid heart rate, and stiff neck can occur.
The health care provider makes a preliminary diagnosis from the medical history, physical examination, and blood tests for infection. To best way to find cavernous sinus thrombosis is magnetic resonance imaging (MRI) of the brain. Sometimes, lumbar puncture will be done to rule out meningitis. In lumbar puncture, the doctor puts a needle in the lower back to get fluid from around the spinal cord to be analyzed for signs of infection.
Treatment involves high-dose intravenous antibiotics. The blood thinner called heparin may be used, but its use is controversial. The use of corticosteroids (anti-inflammatory steroids) is also controversial. In severe cases, a neurosurgeon will drain an infected sphenoid sinus during an operation, when this is the cause.
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