Ver el código de «Cavernous sinus thrombosis»

''The cavernous sinus is one of the several cerebral veins and cavernous sinus thrombosis is a specific type of [[cerebral venous thrombosis|cerebral venous (sinus) thrombosis]].  See that article for a discussion of the larger clinical entity.''

==Background==
*Severe infection involving complications of paranasal sinus and facial infections (e.g. manipulated midface abscesses, furuncles) 
*Frequent extension of thrombosis to opposite sinus 
*Low frequency, but high rate of morbidity/mortality

*Structures within the Cavernous Sinus
**V1 and V2
**III, IV, VI
**Internal Carotid Artery

===Causes===
*[[Staph aureus]]
*[[Strep pneumoniae]]
*[[Gram negative]] bacilli
*[[Anaerobes]]
*[[Fungi]]

==Clinical Features==
*Fevers, chills, nausea and vomiting, headache 
*Eye exam
**infraorbital/periorbital cellulitis
**Exophthalmos (uni/bl)
**Decreased vision
**Absent pupillary reflexes
**Decreased EOM secondary to CN III, IV, VI
***CN VI typically affected 1st causing lateral gaze palsy
**Decreased corneal sensation secondary to CN V 
*If infection spreads into CNS: altered mental status, lethargy, meningeal signs

==Differential Diagnosis==
*Aneurysmal dilation/rupture of internal carotid artery in cavernous sinus 
*[[Cellulitis]]
*[[Periorbital vs Orbital Cellulitis]]
*[[Acute Angle-Closure Glaucoma]]
*[[Sinusitis]]

==Evaluation==
*MRI with MR Venogram - study of choice 
*CT head/orbits with IV contrast
**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT 
*Blood cultures

==Treatment==
*IV antibiotics: 
**3rd generation cephalosporin and: 
**Nafcillin or vancomycin/linezolid if suspected MRSA and <br> 
**Anaerobic coverage if suspected dental source 
*Consider heparin if rapidly decompensating and CT neg for intracranial hemorrhage 
*Consider steroids to decrease inflammation in conjunction with antibiotics 
*Surgical drainage of primary infection if possible

==Disposition==
*Consult ophthalmology, neurology, ID, surgery specialty (if drainage is needed) and admit ICU

==Complications==
*[[Meningitis]]
*Septic emboli
*Remaining visual defects
*CNS deficit
*[[Adrenal Crisis|pituitary insufficiency]]

==See Also==
*[[Cerebral venous thrombosis]]

==References==

[[Category:Ophthalmology]]
[[Category:Neurology]]
[[Category:Vascular]]