Cavernous Sinus Thrombosis

CAVERNOUS SINUS THROMBOSIS eyes

Last Updated May 15th, 2019

Overview

Thrombosis involves the formation of a clot within a blood vessel. When the clot is substantial enough to obstruct the passage of blood, the condition can become very serious and even lead to death. Thrombosis of the cavernous sinuses is one such potentially fatal condition. It is very rare, however, and usually develops as a complication from infections originating elsewhere such as the facial skin or paranasal sinuses. Trauma is another potential cause.

The cavernous sinuses are associated with a number of major nerves and blood vessels servicing the brain and eyes which means that any infection in this area can have debilitating consequences. Cavernous sinus thrombosis (CST) can affect anyone of any age although certain predisposing factors can increase the risk. For instance, young children are more susceptible to infections such as sinusitis which can potentially develop into CST.

 

What Is Cavernous Sinus Thrombosis?

CAVERNOUS SINUS THROMBOSIS eyesCavernous sinus thrombosis (CST) is a rare and life-threatening condition that results when a blood clot is formed in a vein associated with the cavernous sinuses. These sinuses are a pair of hollow cavities located one behind each eye and at the base of the brain. They receive deoxygenated blood from the brain and eyes. From here, this venous blood drains out into another series of sinuses after which it is collected by veins including the internal jugular vein.

Sometimes infections originating in the face or paranasal sinuses can spread to the cavernous sinuses and this is the most common cause of CST. The body attempts to contain the infection by forming a plug of clotted blood in one of the veins draining the cavernous sinuses. Such a clot can obstruct the normal flow of blood through the vein. The bacterium Staphylococcus aureus is normally responsible for infections leading to CST but other bacteria and certain fungi are also possible pathogens.

 

Causes of Cavernous Sinus Thrombosis

The direct cause of CST is an infection. In a majority of cases, the infectious agent is Staphylococcus aureus. Other bacteria such as certain streptococci and pneumococci and even fungi like Aspergillus fumigatus may be responsible. Other possible causes include trauma or injury. A more extensive list of potential causes follows below:

  • Having chronic sinusitis places the patient at a higher risk of developing CST.
  • Boils developing on the facial skin can spread an infection to the cavernous sinuses.
  • Infections arising in the teeth, gums, eyes, and ears can also lead to CST, although this is less common.
  • Presence of bacteria in the blood.
  • Head trauma can lead to the formation of clots in the cavernous sinuses.
  • Having diabetes is a risk factor.
  • Having an underlying health condition that increases the possibility of clotting. For instance, untreated polycythemia vera can lead to the formation of blood clots.
  • Having an inflammatory condition such as systemic lupus erythematosus.
  • Medications such as oral contraceptives can sometimes trigger CST.

 

Symptoms and Signs

CAVERNOUS SINUS THROMBOSISBecause the cavernous sinuses are associated with multiple crucial nerves and blood vessels, the consequences of infection and the resultant clotting can be severe. A headache is a primary symptom. As the condition progresses into the central nervous system, signs of nerve dysfunction such as lowered consciousness and mental confusion may manifest. The typical symptoms of CST are:

  • A severe and persistent headache that gets progressively worse.
  • Bulging of the eyes and swelling of the surrounding area. The swelling typically originates in one eye and eventually spreads to the other within a period of one or two days.
  • Reddening of eyes.
  • Drooping eyelids.
  • Dilation of the pupils; they may also be slow to respond to stimuli.
  • Sensitivity to light.
  • Severe pain in the eyes and inability to move them.
  • Loss of vision or double vision.
  • Where infection is present, high fever is a typical symptom.
  • Pain or numbness in the face.
  • Vomiting.
  • Seizures.
  • Drowsiness and mental confusion.
  • Fatigue

 

Types of Cavernous Sinus Thrombosis

CST can be of two main types, depending on whether or not the infection is present. These are:

  • Septic CST: This is by far the more common kind and typically occurs as a result of infection. This may be classified as either acute or sub-acute mainly depending on how quickly the symptoms appear and escalate.
  • Aseptic CST: Clotting occurs as a result of trauma or other disorders or conditions that predispose the body to form blood clots. Anemia, polycythemia vera or dehydration may be responsible. In the aseptic form, symptoms and complications arising from infection are absent.

 

Complications of Cavernous Sinus Thrombosis

In the event that infection spreads beyond the cavernous sinuses, it can travel to the brain and cause meningitis. The infection may also spread throughout the bloodstream, leading to blood poisoning. As the symptoms of CST escalate, the patient eventually descends into a coma following which death is the most likely outcome.

CST calls for an urgent medical response without which fatality is almost certain. Those who survive may continue to experience severe headaches or seizures over the long term. Permanent blindness is less common but vision impairment to some degree is likely. The patient may also be left with impaired pituitary function. Further, the likelihood of developing clots in other locations is increased. Stroke can occur if such clots appear in the arteries of the brain.

 

Diagnosing Cavernous Sinus Thrombosis

CAVERNOUS SINUS THROMBOSIS painIn view of the potentially fatal or debilitating outcomes of cavernous sinus thrombosis, it is extremely crucial to obtain a prompt and accurate diagnosis. Since the condition is rare, it is possible to mistake it for other more common disorders. Initially, the symptoms resemble those of orbital cellulitis but if signs of mental confusion are involved, then it is likely that the patient is suffering from a case of CST. A recent history of infections such as sinusitis may alert the physician to a possible diagnosis of CST.

A sample of cerebrospinal fluid will need to be extracted by means of lumbar puncture in order to check for infection. In 3 out of 4 cases, sepsis will have extended to the cerebrospinal fluid ruling out localised infections such as sinusitis. This does not, however, necessarily confirm CST. Likewise, blood cultures are helpful but not conclusive.

X-raying the sinuses may also be necessary. Magnetic resonance venography is necessary in order to confirm a diagnosis of CST. Carotid angiography can reveal any disturbance to the internal carotid arteries as they pass through the cavernous sinuses.

 

Treatment and prevention

Heavy antibiotics are used to treat CST, for at least 3-4 weeks continuously as it is caused due to infections. Blood thinners are provided to try and reduce the size of the clot these are provided intravenously (IV). Seek out treatment early in cases of sinusitis, head injury or any other infection or disease as CST is caused due to their aggravation.

 

Facts

  • Cavernous sinus thrombosis (CST) was first described by Bright in 1831 as a complication of the epidural and subdural infection.
  • This condition is very rare and life-threatening as a vein that is present at the hollow space beneath the brain and under the eye sockets gets blocked due to a blood clot.

Facts

  • This vein carries blood from the heart to the brain and vice-versa.
  • The main cause of CST is an infection, but other factors play a major as well.

Facts

  • CST is mostly caused due to the spreading of contagious infections such as – nasal furuncle (50% chances of developing CST), sphenoidal or ethmoidal sinuses (30% chances of developing CST) and dental infection (10% chances of developing CST)
  • Double vision and seizures are rare conditions.

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Dos and Don'ts

Dos
  • Visit the doctor as soon as you notice any of the symptoms.
  • Since it is a blood clot a CT or MRI scan would be needed to see the size and exact location of the clot in the vein.
  • Depending on what the doctor says a blood culture would be needed to see the bacteria levels in the body for further treatment.
Don'ts
  • Overlook a boil that could have formed in a hair follicle as this could be an indication of the blood clots location and bursting the boil could spread the infection.
  • Overlook the medications that you take to make sure that they do not have any adverse affect on you. For instance, contraceptive pills in very rare cases.
  • Take head injuries lightly and get them checked out. To make sure that there are no serious complication in the future.

 

 

 

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Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
immunoglobulin M
Immunoglobulin M Test Immunoglobulin M is the largest and the first produced antibody which helps in the prevention or fighting of…
ureteroscopy
Ureteroscopy Ureteroscopy is the diagnostic procedure which is used for the detection of the kidney stones in addition to…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
eating disorder anorexia
Eating Disorders: Lifestyle choice or a psychological condition? Is eating disorder just a harmless bad habit? Or does it represent grim psychological disorders? Do you want…
Beware of these common foods that cause high bodily inflammation! Maybe its the long list of inflammatory foods in your diet that is making you frequently sick. Find…
Find all the instant ways to get rid of blackheads Blackheads - Not only are they aesthetically unappealing but if left untreated these can cause bacterial overgrowth on…
Oxalates: How healthy greens can sometimes be bad news for your kidneys Oxalates are compounds present in a majority of healthy foods. However, at times an overconsumption of these could…
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
quinoa salad
Quinoa : A prodigious superfood you need to include in your diet today! Quinoa - what is so special about this native South American grain that has taken the world by…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
improve digestion weight loss
Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
bananas exercise
10 health reasons why you should go “bananas” over bananas! Bananas:The world's most popular fruit comes with a host of unbelievable health benefits. Find out how you can…
ashwagandha brain
Ashwagandha: The best-kept secret of Ayurveda now revealed! Ashwagandha literally means "smell of horse". Don't get bogged down by that one tiny detail because this ayurveduic…
Salt dangers
Sodium chloride: The wonders and dangers of the simple table salt Sodium chloride is a salt containing sodium and chlorine ions at a 1:1 ratio. It is edible and…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
The right way to prepare Alfalfa sprouts at home Alfalfa or lusan ghas is not just a nutritious animal fodder. This flavonoid-rich herb has some amazing health…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
How to scrub away stress and fatigue with an Epsom salt bath? Epsom salt is a popular home remedy for many skin ailments. Though there is a lack of scientific…
thyroid_scan
Thyroid Scan Thyroid scan is a diagnostic procedure that aims to view the thyroid gland and detect any growths or…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
lp-pla2
LP-PLA2 Test The LP-PLA2 test is a test which is carried out to assess the levels of Lipoprotein-Associated Phospholipase A2…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
shoudler exercises
Keep your shoulders pain-free with these shoulder exercises Shoulder exercises are important in order to prevent chronic back and neck pain. Learn more about how you…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…