What are the symptoms of cavernous sinus thrombosis (CST)?

From the Guidelines

Cavernous sinus thrombosis typically presents with severe headache, high fever, and eye symptoms such as proptosis, periorbital edema, chemosis, and ophthalmoplegia, which can rapidly progress to involve both sides and lead to altered mental status, seizures, and signs of increased intracranial pressure. The symptoms of cavernous sinus thrombosis can be variable, but they often include a combination of headache, fever, and eye symptoms due to the involvement of the cranial nerves and vascular structures within the cavernous sinus 1. The headache is typically severe and can be accompanied by pain behind the eyes, while the eye symptoms can include blurry or double vision, ptosis, and limited eye movement due to cranial nerve palsies affecting the third, fourth, and sixth cranial nerves.

Clinical Presentation

The clinical presentation of cavernous sinus thrombosis can be divided into several key features, including:

• Severe headache, which is often the most common symptom
• High fever, which can be accompanied by other signs of infection such as chills and malaise
• Eye symptoms, including proptosis, periorbital edema, chemosis, and ophthalmoplegia
• Vision changes, such as blurry or double vision
• Pain behind the eyes, which can be severe
• Cranial nerve palsies, which can lead to ptosis and limited eye movement

Diagnosis and Management

The diagnosis of cavernous sinus thrombosis is typically based on clinical suspicion and imaging confirmation, with MRI and MRV being the most sensitive and specific tests for detecting thrombosis in the cavernous sinus 1. The management of cavernous sinus thrombosis typically involves immediate treatment with broad-spectrum antibiotics and anticoagulation therapy to prevent further clot formation and spread of infection. The choice of antibiotics and anticoagulants will depend on the underlying cause of the thrombosis and the presence of any contraindications to treatment.

Key Considerations

In patients with suspected cavernous sinus thrombosis, it is essential to:

• Obtain imaging studies, such as MRI and MRV, to confirm the diagnosis
• Initiate broad-spectrum antibiotics and anticoagulation therapy as soon as possible
• Monitor the patient closely for signs of increased intracranial pressure, seizures, and altered mental status
• Consider the use of endovascular therapy or decompressive hemicraniectomy in patients with severe symptoms or contraindications to anticoagulation therapy 1.

From the Research

Symptoms of Cavernous Sinus Thrombosis

The symptoms of cavernous sinus thrombosis (CST) can be severe and life-threatening. Some of the most common symptoms include:

• Fever, which is almost always present 2
• Headache, although it may not be noticeable in some cases 2
• Ocular manifestations, such as:
  • Chemosis (swelling of the conjunctiva) 3, 2
  • Periorbital edema (swelling around the eyes) 3, 2
  • Ptosis (drooping of the eyelid) 3
  • Ophthalmoplegia (paralysis of the eye muscles) 3
  • Vision changes 3
• Cranial nerve (CN) palsies, particularly:
  • CN VI, resulting in lateral rectus palsy 3
  • CN III, IV, and V may also be affected 3
• Restriction of extraocular movements, particularly lateral gazing 2
• Proptosis (bulging of the eye) 2

Other Possible Symptoms

In addition to the above symptoms, CST can also affect the pulmonary and central nervous systems 3. It is essential to recognize these symptoms promptly to initiate appropriate treatment and prevent long-term morbidity or mortality.