Cavernous sinus thrombosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Natural History, Complications, and Prognosis

Natural History

The symptoms of cavernous sinus thrombosis may vary depend on the anatomical structures involved.[1]

  • The most common symptoms of cavernous sinus thrombosis include:
    • Severe holocranial and bifrontal headache whit increasing severity[1][2][3]
    • Fever[1][2][3]
    • Proptosis[1]
    • Chemosis[1]
    • External ophthalmoplegia[1][3]
    • Periorbital swelling redness in one or both eyes[1][3]
  • Other symptoms of cavernous sinus thrombosis include:
    • Drooping eyelids[1][3]
    • Decreased visual acuity[1][3]
    • Vision loss or double vision[3]
    • Inability to move the eye[3]
    • Periorbital sensory loss[1]
    • Pain or numbness around the face or eyes[1]
    • Fatigue[1]
    • Seizures[4]
    • Lethargy[1]

Complications

  • Common complications of cavernous sinus thrombosis include:
    • [Complication 1]
    • Bilateral blindness
    • Seizures[4]

Prognosis

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Yeo GS, Kim HY, Kim H, Kwak EJ, Jung YS, Park HS; et al. (2014). "Cavernous sinus thrombosis caused by a dental infection: a case report". J Korean Assoc Oral Maxillofac Surg. 40 (4): 195–8. doi:10.5125/jkaoms.2014.40.4.195. PMC 4170663. PMID 25247150.
  2. ↑ 2.0 2.1 Botta R, Donirpathi S, Yadav R, Kulkarni GB, Kumar MV, Nagaraja D (2017). "Headache Patterns in Cerebral Venous Sinus Thrombosis". J Neurosci Rural Pract. 8 (Suppl 1): S72–S77. doi:10.4103/jnrp.jnrp_339_16. PMC 5602266. PMID 28936075.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Mallick A, Pathak SD, Shankar S, Sati A (2015). "Early cavernous sinus thrombosis following unilateral pansinusitis in a child". BMJ Case Rep. 2015. doi:10.1136/bcr-2014-208441. PMC 4422932. PMID 25917067.
  4. ↑ 4.0 4.1 Sha DJ, Qian J, Gu SS, Wang LN, Wang F, Xu Y (2018). "Cerebral venous sinus thrombosis complicated by seizures: a retrospective analysis of 69 cases". J Thromb Thrombolysis. 45 (1): 186–191. doi:10.1007/s11239-017-1570-5. PMC 5756278. PMID 29039017.

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Natural History

In reality, most patients with cavernous sinus thrombosis do not present with such serious illness, and if they survive tend to have a better prognosis than patients with arterial thrombosis. The real trick is suspecting and making the diagnosis.

Complications

Progressive coma and death with hemorrhagic infarction pathologically.

Prognosis

  • Prognosis better as diagnosis is increasing made with imaging instead of autopsy, with mortality rates down from 100% to 6.5% in a recent review of 76 patients.
  • Poor prognostic features:
    • Rapid progression
    • Coma
    • Extremes of age
    • Focal signs and symptoms
    • Hemorrhagic infarct
    • Serious underlying cause
  • Of note, if patient survives, outcome is better than for arterial infarct

References


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