Cavernous sinus thrombosis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Pathophysiology

Anatomy

  • Anatomy:
    • Cerebral veins --> Dural sinuses --> Internal jugular veins
    • The Cerebral veins include:
      • Superficial cerebral veins
        • Anatomy quite variable
      • Deep cerebral veins
      • Veins of the posterior fossa
    • The Dural sinuses most commonly affected by thrombosis are:
      • Superior sagital sinus
        • Drains most of cortex
        • Also fed by scalp emissary veins
        • Contains most of arachnoid villi responsible for draining CSF – obstruction increases intracerebral pressure
        • Superior sagital sinus thrombosis may only result in massive brain edema.
      • Lateral sinus
        • Drains cerebellum, brain stem, posterior cerebral hemispheres, middle ear
        • Near mastoid and inner ear, and susceptible to infections there
      • Cavernous sinus
        • Drains ophthalmic veins, anterior base of brain
        • Near, and susceptible to infection of face, sphenoid sinuses, teeth, and ear – infection (particularly with Staph aureus, fungus) is leading cause of cavernous sinus thrombosis, and cavernous sinus thrombosis is most common cerebral venous thrombosis.
        • Near oculomotor nerve, ophthalmic nerve, trigeminal nerve, abducens nerve, carotid artery and its surrounding sympathetic plexus.

Pathogenesis

  • Pathogenetic factors:
    • Venous stasis
    • Hypercoagulability
    • Vessel wall changes
    • Embolization

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