What is cavernous sinus thrombosis sinusitis infection. Enlargement and expansion of the sinuses with bulging or convex lateral walls on coronal scans has been considered to be an important indicator of cavernous sinus lesions 20,22. Cavernous sinus thrombosis cst is the formation of thrombus clot within the cavernous sinus, which can either be septic or aseptic. All statistical analysis was performed using ibm spss software version 22. It arises from a complication due to facial infections. The introduction of intravenous contrast can reveal filling defects within the cavernous sinus. Cavernous sinus thrombosis is a lifethreatening complication that may rarely result from infection spreading back through the emissary veins from the maxillary or nasal region, or upper teeth, or from infected thrombi in the anterior facial vein or less commonly the pterygoid plexus. Cavernous sinus thrombosis is a potentially lifethreatening condition that can happen after an infection in your head. Cerebral sinus venous thrombosis pubmed central pmc. These lesions may arise in the cavernous sinus proper or may secondarily infiltrate the cavernous sinus. A carotid cavernous fistula ccf is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as. Cavernous sinus thrombosis definition of cavernous sinus.
Diffusionweighted magnetic resonance in cerebral venous. Review article imaging lesions of the cavernous sinus a. Cavernous sinus thrombosis is a very serious condition. Over a twoyear period, all ct venograms ctvs performed at our institution were.
Cerebral venous thrombosis cvt is a thrombotic obstruction of the cerebral venous system that may lead to ischemic lesions or hemorrhages in the brain. Infections may also be introduced by facial lacerations and by bursting pimples in the areas drained by the facial vein. Apr 05, 2019 the diagnosis of thrombosis of the cavernous sinus is clinically done using the imaging techniques from proptosis, ptosis, chemosis and cranial nerve palsy in one eye associated to the other eye. Current techniques, spectrum of findings, and diagnostic pitfalls. Heterogenous signal intensity of the sinus on plain mri should prompt evaluation. Due to diverse clinical presentation of cerebral venous thrombosis it is often under diagnosed. The following findings on performing mri are confirmatory for cavernous sinus thrombosis. Cavernous sinus thrombosis article about cavernous sinus. Cavernous sinus syndrome is a broad category of pathology that is often difficult to diagnose or define but can encompass damage to the ocular nerves andor the pupil, bloodshot conjunctiva, a reddening in parts of the face, changes in facial sweating, and other symptoms associated with horners syndrome. From there the infection may spread to the dural venous sinuses. Computed tomography and magnetic resonance imaging plays an important role in the management of this disease. This condition is uncommon but a serious one and affects both children and adults.
Cavernous sinus thrombosis in children stroke aha journals. Some people who survive will develop longterm health problems due to damage to their brain, such as persistent headaches and fits, or some degree of vision loss. Jun 20, 2014 thrombosis of cerebral veins or venous sinuses is a much less common cause of cerebral infarction than that caused by arterial disease. Imaging helps in identifying thrombosis either via direct visualisation of the thrombus filling defect in cavernous sinus or via indirect signs that include proptosis, dilatation of the draining tributaries and abnormal dural enhancement, that are well demonstrated on contrast enhanced studies 7. Cavernous sinus thrombosis cst is a rare and a fulminant life. The fissure and the anterior cavernous sinus contain the same structures, and determining which is involved in the absence of orbital mass signs is dependent on imaging. We report on the imaging characteristics of two different histopathological types of cavernous sinus cavernous hemangiomas and the use of contrastenhanced mri, diffusionweighted mri and magnetic resonance spectroscopy in the differential diagnosis of these lesions. Enhanced ct is the preferred tool to diagnose ijv thrombosis. Cavernous sinus thrombosis an overview sciencedirect topics. Ecr 2017 c2829 10 minutes imaging in acute cerebral venous. These include dural venous sinus thrombosis, cortical vein thrombosis, cavernous sinus thrombosis, venous infarctionhaemorrhage, and the rare sequelae of intracranial hypertension or dural arteriovenous fistula.
Cavernous sinus thrombosis is more common in patients with diabetes and those with an immunocompromised status. Cavernous sinus thrombosis treatment algorithm bmj best. Magnetic resonance imaging mri with mr venography is the gold standard test for the diagnosis of cavernous sinus thrombosis. Ct and mr angiograms are also able to depict abnormal vascular changes, including engorged venous sinuses or cortical vein drainage, arterial or venous aneurysm formation, and arterial. Clinical features and differential diagnosis with mr imaging. In current practice, computed tomography ct scan or magnetic resonance imaging mri with contrast is the modality of choice to confirm the. One of the most unusual and grave conditions is cavernous sinus thrombosis cst. The most common are neurogenic tumors and cavernoma. The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic. Diagnostic value of multidetectorrow ct angiography in the. Diagnostic value of multidetectorrow ct angiography in the evaluation of thrombosis of the cerebral venous sinuses. Anteroposterior mip image from contrastenhanced mr venography, with the superficial and deep veins removed for better visualization, shows the cavernous sinus complex 1 and, connecting the lateral dural sinuses with the cavernous sinus, the superior petrosal sinuses 2, which arise from the junction of the transverse and sigmoid sinuses and. Cavernous sinus thrombosis causes symptoms such as abnormally bulging eyes that occurs over days, swelling of the eyelid, severe headache, facial pain or numbness, impaired eye movements ophthalmoplegia with double vision, loss of vision, drowsiness, a high fever, and excessively dilated or uneven pupils.
Absent flow void in t1 and t2 and signal characteristics vary depending on the age of the thrombus but will be abnormal. Additional testing for this case included magnetic resonance imaging mri with and without gadolinium. These sinuses are just lateral and superior to the sphenoid sinus and are immediately posterior to the optic chiasm, as depicted in the image. The diagnosis of thrombosis of the cavernous sinus is clinically done using the imaging techniques from proptosis, ptosis, chemosis and cranial nerve palsy in one eye associated to the other eye. This is a rare disorder and can be of two typesseptic cavernous thrombosis and aseptic cavernous thrombosis. Cerebral venous sinus thrombosis occurs when a blood clot forms in the brains venous sinuses. Diffusionweighted imaging dwi, first developed by le bihan et al, 1 can detect changes in water diffusion associated with cellular dysfunction and can be used to detect ischemic lesions of the brain within the first few hours of stroke onset. Cavernous sinus thrombosis is typically a complication of a facial or orbital infection and often presents with proptosis, chemosis, and painful ophthalmoplegia. Cavernous sinus thrombosis the cavernous sinus is one of the several cerebral veins and cavernous sinus thrombosis is a specific type of cerebral venous sinus thrombosis. Based on the affected venous structures, the following subtypes of cvst can be distinguished. Other differential diagnosis of petrous apicitis including congenital cholesteatoma, intracranial abscess, lateral sinus thrombosis, cholesterol granuloma, temporal bone osteomyelitis, and neoplastic or granulomatous disease were excluded. The cs, notwithstanding its small size, contains a complicated and crucial network that consists of the carotid artery, the venous plexus, and cranial nerves. The infection may spread to involve the cerebrospinal fluid and meninges.
Cavernous sinus thrombosis is usually caused by the spread of bacteria from infections of the face and orbit including the skin of the nose, orbit, or sinus. Sep 07, 2010 lateral sinus thrombosis is now a rare intracranial complication of otitis media. Most commonly the form is of septic cavernous sinus thrombosis. Other causes include bacteremia, trauma, and infections of the ear or maxillary teeth. Symptoms and signs include pain, proptosis, ophthalmoplegia, vision loss, papilledema, and fever. The filling defect is typically seen on multiple sections in contrastenhanced ct and mr imaging studies.
Imaging lesions of the cavernous sinus american journal of. Tributary venosinus occlusion and septic cavernous sinus thrombosis. While its highly unlikely to be the result of cavernous sinus thrombosis, a persistent headache usually needs to be investigated. The imaging studies also revealed the presence of cavernous sinus thrombosis and carotid septic stenosis. Cavernous sinus thrombosis cst is a rare condition, most commonly infectious in nature, and the diagnosis on imaging is not always straightforward. Treatment and management of venous sinus thrombosis. The cavernous sinus extends posteriorly from the superior orbital fissure to the dorsum sella. It is caused by a bacterial infection that typically originates in the face, sinuses, ears, or orbits 1. A preoperative diagnosis is therefore important to alert the surgeon. Cerebral venous sinus thrombosis, a nonenhanced ct diagnosis. The cavernous sinus is one of the several cerebral veins and cavernous sinus thrombosis is a specific type of cerebral venous sinus thrombosis.
Ct and mr imaging can provide diagnostic information with direct signs, including changes in signal intensity and in the size and contour of the cavernous sinus, and indirect signs, including dilatation of the tributary veins, exophthalmos, and increased dural enhancement along the lateral border of the cavernous sinus figs. Cavernous sinus thrombosis eye disorders msd manual. Mr imaging of cavernous sinus thrombosis european journal. Cavernous sinus thrombosis is a very rare, lifethreatening condition that can affect adults and children in cavernous sinus thrombosis, a blood clot blocks a vein that runs through a hollow.
It frequently occurs in association with other intracranial complications. Cavernous sinus thrombosis cst is a severe disease which can result from infection of any of the tissues drained by the cavernous sinus. Jul 16, 2018 cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. Cavernous sinus thrombosis is a condition where a blood clot forms in the region under your brain and at the back of the eye socket. Mar 22, 2018 cavernous sinus thrombosis is a potentially lifethreatening condition that can happen after an infection in your head. The present study is a case report of acute otitis media which led to septic cavernous sinus thrombosis in a 56yearold woman in bojnord city, north khorasan, iran. What is the role of ct scanning in the workup of cavernous. The thrombophlebitis can also be located in the cavernous sinus.
These symptoms usually occur if cavernous sinus thrombosis is left untreated, or if an infection causing the condition spreads throughout the body. All the 60 patients were subjected to mri for the diagnosis of cvt. Imaging characteristics of cavernous sinus cavernous. Jan 24, 2017 cavernous sinus thrombosis shyni dharipelly. Ecr 2017 c2829 10 minutes imaging in acute cerebral venous sinus thrombosis by. Review article imaging lesions of the cavernous sinus. These clots obstruct the vein in the aforementioned area of your body. In cavernous sinus thrombosis, ocular signs dominate the clinical picture with orbital pain, chemosis, proptosis, and septic dural sinus thrombosis view in chinese suggest early heparinization in patients with unilateral cavernous sinus thrombosis. Treatment and management of venous sinus thrombosis sebastian pollandt, md neurocritical careepilepsy. The dural sinuses are grouped into the sagittal, lateral including the transverse, sigmoid, and petrosal sinuses, and cavernous sinuses. Mri is useful to depict cavernous sinus involvement. Caroticocavernous fistulas ccf represent abnormal communication between the carotid circulation and the cavernous sinus.
Professor of radiology and biomedical imaging, yale university school of medicine. Morphologic changes such as dilation of the sov, cavernous sinus, and protrusion of the globe have been well demonstrated by contrastenhanced ct and mr imaging. Septic lateral sinus thrombosis is an infrequent complication of otitis media or mastoiditis and often presents with headaches, fever, otalgia, vertigo, papilledema, and abducens. Septic cst is a rapidly evolving thrombophlebitic process with an infectious origin typically from the middle third of the face, sinuses, ears, teeth, or mouth, affecting the cavernous sinus and its structures. Mr imaging of cavernous sinus thrombosis sciencedirect. Cavernous sinus thrombosis is generally a fulminant process with high rates of morbidity and mortality.
Cerebral venous sinus thrombosis cvst is an uncommon. You may also need to participate in a special rehabilitation program or physical therapy, if you have. Imaging techniques and laboratory tests are used for diagnosing this condition. Leach et al october 2006 radiographics, 26, s19s41. It is mostly caused by an infection with high morbidity and mortality rate. Immediately evaluate patients who present with fever, somnolence or a toxic appearance for evidence of cavernous sinus thrombosis or mucormycosis. Caroticocavernous fistula radiology reference article. Mri with mr venogram mrv is the preferred imaging choice as the mrv will show the absence of venous flow in the affected cavernous sinus. Repeat head imaging showed progression of cvst thrombosis despite anticoagulation. Cavernous sinus thrombosis is a very rare disorder in which a blood clot thrombosis forms in the cavernous sinus a large vein at the base of the skull. Cavernous sinus thrombosis cst is a rare condition, defined as a septic thrombophlebitis of the cavernous sinus. Review the imaging findings ct and mri in isolated cortical venous thrombosis icvt.
Role of imaging is to throw light on the nature of lesion, its relationship to crucial neurovascular structures, and its extension into the adjoining structures. Cerebral sinus venous thrombosis csvt is a rare form of venous thromboembolism vte. Conclusions findings of laboratory tests and magnetic resonance imaging mri confirmed the clinical diagnosis. Thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. Pdf mr imaging of cavernous sinus thrombosis researchgate. These images are a random sampling from a bing search on the term cavernous sinus thrombosis. Cavernous sinus thrombosis cst is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. Clinically the diagnosis can be very difficult but modern imaging techniques allow earlier diagnosis and the possibility of early treatment. Cerebral venous and sinus thrombosis cvst is a rare but important cause of. See that article for a discussion of the larger clinical entity.
Cavernous sinus thrombosis eye disorders merck manuals. Orbital imaging or surgery is necessary to make the diagnosis septic cavernous sinus thrombosis bilateral ptosis, proptosis, ophthalmoplegia, periorbital edema, headache, change in approach to acute vision loss in children view in chinese. Cavernous sinus thrombosis cst is an uncommon clinical condition caused by blood clot formation that obstructs the cavernous cavity. On noncontrast ct, thrombosis of the cavernous sinus can be appreciated as increased density. Cerebral venous sinus thrombosis cvst johns hopkins medicine. Cavernous sinus thrombosis is treated with highdose antibiotics given through a vein iv if an infection is the cause. Surgery is sometimes needed to drain the infection. An awareness of this condition is necessary for early diagnosis and treatment.
Cavernous sinus thrombosis msd manual consumer version. Feb 25, 2018 cerebral venous thrombosis venous sinus thrombosis is caused by clots in the dural venous sinuses and accounts for 0. Cvt results in an increased venous pressure that can lower cerebral perfusion pressure and induce parenchymal change due to vasogenic edema, cytotoxic edema, or intracranial hemorrhage. Highest recanalization rates in deep cerebral veins and cavernous sinus thrombosis, lowest in lateral sinus thrombosis. The condition can occur in all age groups and affects women more than men, who have a higher risk of predisposing factors such as prothrombotic conditions, pregnancy, oral contraceptive use, malignancy, and infection.
Cavernous sinus thrombosis is usually a late complication of an infection of the central face or paranasal sinuses. Imaging signs of cavernous sinus thrombosis include a bulky cavernous sinus, a convex configuration of the lateral wall, and filling defects within the sinus. Read more about symptoms, diagnosis, treatment, complications, causes and. Blood thinners help dissolve the blood clot and prevent it from getting worse or recurring. Cavernous sinus on imaging shows concave lateral walls on coronal images.
Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. Treatment cavernous sinus thrombosis is treated with highdose antibiotics given through a vein iv if an infection is the cause. Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Without treatment, most people with cavernous sinus thrombosis will become increasingly drowsy and eventually fall into a coma. The diagnosis of cavernous sinus thrombosis is usually predicted clinically, but one should not only be aware of its various imaging findings, but, should also be familiar with certain proposed parameters as mri is commonly carried out in such patients to see the extent of disease, associated complications and to establish the etiology of.
Alternatively referred to as cerebral venous sinus thrombosis cvst or dural venous sinus thrombosis dvst, the terms encompass a broad spectrum of neurological pathologies. Cavernous sinus thrombosis cst is a rare and a fulminant lifethreatening. Cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. Cavernous sinus thrombosis symptoms, diagnosis and. To learn the normal cerebral venous anatomy and variants. Its marked by a blood clot behind your eyes or at the base of your skull. After an examination, you may be referred for tests, including a computerised tomography ct scan, a magnetic resonance imaging mri scan and blood tests. This involves a blood clot developing in the cavernous sinuses of the skull which are hollow spaces beneath the base of the brain found at the back of the eye sockets. Imaging of the cavernous sinus lesions sciencedirect. The infection in the blood and cerebrospinal fluid are also tested to diagnose the cavernous sinus thrombosis.
In our study, transverse diameter in controls was reported as 6. Imaging lesions of the cavernous sinus american journal. Imaging characteristics include cavernous sinus expansion, filling defects, restricted diffusion, arterial wall enhancement, empyema, superior. Cavernous sinus thrombosis symptoms, treatment, causes. A welldescribed finding of sinus thrombosis at contrastenhanced imaging is the empty delta sign, a central intraluminal filling defect that represents a thrombus surrounded by contrastenhanced dural collateral venous channels and cavernous spaces within the dural envelope, fig 10, 27, 28. Click on the image or right click to open the source website in a new browser window. Tumors of the nasopharynx, skull base, and sphenoid sinus may extend to the cs as can perineural and hematogenous metastases. Clinical features and differential diagnosis with mr imaging jeong hyun lee 1, ho kyu lee 1, ji kang park 2, choong gon choi 1 and dae chul suh 1 audio available share.
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