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question imp Cavernous sinus thrombosis

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1 question imp Cavernous sinus thrombosis on Sat Jul 09, 2011 11:32 am

amy

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Cavernous sinus thrombosis

is a very rare, typically septic, thrombosis of the cavernous sinus, usually caused by bacterial sinusitis. Symptoms and signs include pain, proptosis, ophthalmoplegia, vision loss, papilledema, and fever.Diagnosis is confirmed by CT or MRI. Treatment is with IV antibiotics.
Complications are common, and prognosis is poor.
The cavernous sinuses are trabeculated sinuses located at the base of the skull that drain venous blood from facial veins.

Cavernous sinus thrombosis (CST) is an extremely rare complication of common facial infections, most notably nasal furuncles (50%), sphenoidal or ethmoidal sinusitis (30%), and dental infections (10%). Most common pathogens are Staphylococcus aureus (70%), followed by Streptococcus sp; anaerobes are more common when the underlying cause is dental or sinus infection.
Thrombosis of the lateral sinus (related to mastoiditis) and thrombosis of the superior sagittal sinus (related to bacterial meningitis) occur but are rarer than CST.
Pathophysiology
The 3rd, 4th, and 6th cranial nerves and the ophthalmic and maxillary branches of the 5th cranial nerve are adjacent to the cavernous sinus and are commonly affected. Complications include meningoencephalitis, brain abscess, stroke, blindness, and pituitary insufficiency.
Initial symptoms are progressively severe headache or facial pain, usually unilateral and localized to retro-orbital and frontal regions. High fever is common. Later, ophthalmoplegia (initially the 6th cranial nerve, lateral gaze), proptosis, and lid edema develop and often become bilateral.

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