What are the symptoms of cavernous sinus thrombosis?

Symptoms of Cavernous Sinus Thrombosis

Cavernous sinus thrombosis (CST) typically presents with headache, fever, periorbital edema, chemosis, proptosis, and limitation of extraocular movements, particularly lateral gaze due to sixth cranial nerve involvement. 1, 2

Common Clinical Manifestations

• Headache is the most common symptom, occurring in nearly 90% of patients, typically diffuse and progressively worsening over days to weeks 3
• Fever is a nearly constant finding in septic cavernous sinus thrombosis 1, 2
• Ocular manifestations include:
  • Periorbital edema and chemosis (conjunctival swelling) 1, 4
  • Proptosis (bulging of the eye) 5, 4
  • Limited extraocular movements, especially lateral gaze due to sixth nerve palsy 1, 2
  • Ptosis (drooping of the eyelid) 5, 4
  • Visual impairment or vision loss 5, 4
• Involvement of the opposite eye frequently appears within two days following the onset of unilateral signs 1, 2

Neurological Symptoms

• Cranial nerve palsies, with cranial nerve VI (abducens) most commonly affected, resulting in lateral rectus palsy 4
• Other cranial nerves that may be affected include III (oculomotor), IV (trochlear), and V (trigeminal) 4
• Altered mental status, especially with progression of disease 3, 5
• Focal neurological deficits may develop as the condition progresses 3

Symptoms Related to Underlying Cause

• Symptoms related to paranasal sinusitis (particularly sphenoid sinusitis), which is a common cause 6
• Signs of infection in the middle third of the face, often due to Staphylococcus aureus 1, 2
• History of dental abscess or otitis media may be present 1, 2

Complications and Advanced Symptoms

• Seizures may occur as the condition progresses 3
• Severe headache, photophobia, and focal neurologic findings may indicate intracranial involvement 6
• In advanced cases, patients may develop:
  • Acute cerebral infarction 5
  • Intracerebral hemorrhage 7
  • Aneurysmal subarachnoid hemorrhage (rare) 5
  • Coma and cardiorespiratory arrest in severe cases 5

Clinical Pitfalls

• CST may be confused with other conditions, as symptoms can overlap with other orbital or neurological disorders 6
• Isolated headache without focal neurological findings occurs in up to 25% of patients with cerebral venous thrombosis, presenting a significant diagnostic challenge 6
• Symptoms may initially be vague, particularly with sphenoid sinusitis as the underlying cause 6
• The mortality rate remains high (approximately 30%) if not recognized and treated promptly 1, 2

Early recognition of these symptoms is crucial as prompt diagnosis and treatment significantly improve outcomes in this potentially life-threatening condition 4.