Infections may also be introduced by facial lacerations and by bursting pimples in the areas drained by the facial vein. Cavernous sinus thrombosis is more common in patients with diabetes and those with an immunocompromised status. Heterogenous signal intensity of the sinus on plain mri should prompt evaluation. Cavernous sinus thrombosis cst is a severe disease which can result from infection of any of the tissues drained by the cavernous sinus. Most commonly the form is of septic cavernous sinus thrombosis. Cerebral sinus venous thrombosis csvt is a rare form of venous thromboembolism vte. Without treatment, most people with cavernous sinus thrombosis will become increasingly drowsy and eventually fall into a coma.
Review article imaging lesions of the cavernous sinus a. Cavernous sinus thrombosis in children stroke aha journals. This condition is uncommon but a serious one and affects both children and adults. 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. This is a rare disorder and can be of two typesseptic cavernous thrombosis and aseptic cavernous thrombosis. Diagnostic value of multidetectorrow ct angiography in the evaluation of thrombosis of the cerebral venous sinuses. 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.
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. Click on the image or right click to open the source website in a new browser window. Cavernous sinus thrombosis is generally a fulminant process with high rates of morbidity and mortality. Enhanced ct is the preferred tool to diagnose ijv thrombosis.
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. Cavernous sinus thrombosis msd manual consumer version. 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. 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. The cs, notwithstanding its small size, contains a complicated and crucial network that consists of the carotid artery, the venous plexus, and cranial nerves. 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. 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.
Cavernous sinus thrombosis eye disorders merck manuals. Absent flow void in t1 and t2 and signal characteristics vary depending on the age of the thrombus but will be abnormal. 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. The most common are neurogenic tumors and cavernoma. 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. 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. Blood thinners help dissolve the blood clot and prevent it from getting worse or recurring. Cerebral venous sinus thrombosis, a nonenhanced ct diagnosis.
Cavernous sinus thrombosis treatment algorithm bmj best. In our study, transverse diameter in controls was reported as 6. Magnetic resonance imaging mri with mr venography is the gold standard test for the diagnosis of cavernous sinus thrombosis. All the 60 patients were subjected to mri for the diagnosis of cvt. Immediately evaluate patients who present with fever, somnolence or a toxic appearance for evidence of cavernous sinus thrombosis or mucormycosis. Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. A preoperative diagnosis is therefore important to alert the surgeon. The dural sinuses are grouped into the sagittal, lateral including the transverse, sigmoid, and petrosal sinuses, and cavernous sinuses. Cavernous sinus on imaging shows concave lateral walls on coronal images. Over a twoyear period, all ct venograms ctvs performed at our institution were. Thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. Leach et al october 2006 radiographics, 26, s19s41.
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. Cerebral venous thrombosis cvt is a thrombotic obstruction of the cerebral venous system that may lead to ischemic lesions or hemorrhages in the brain. Cavernous sinus thrombosis definition of cavernous sinus. Cavernous sinus thrombosis article about cavernous sinus. Symptoms and signs include pain, proptosis, ophthalmoplegia, vision loss, papilledema, and fever. Jan 24, 2017 cavernous sinus thrombosis shyni dharipelly. The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic. 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. Repeat head imaging showed progression of cvst thrombosis despite anticoagulation. Sep 07, 2010 lateral sinus thrombosis is now a rare intracranial complication of otitis media.
Cerebral venous sinus thrombosis cvst is an uncommon. What is cavernous sinus thrombosis sinusitis infection. It arises from a complication due to facial infections. Cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. These sinuses are just lateral and superior to the sphenoid sinus and are immediately posterior to the optic chiasm, as depicted in the image. 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. Cavernous sinus thrombosis an overview sciencedirect topics. Cavernous sinus thrombosis cst is an uncommon clinical condition caused by blood clot formation that obstructs the cavernous cavity.
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. Diffusionweighted magnetic resonance in cerebral venous. Cavernous sinus thrombosis is a very serious condition. Other causes include bacteremia, trauma, and infections of the ear or maxillary teeth. While its highly unlikely to be the result of cavernous sinus thrombosis, a persistent headache usually needs to be investigated. 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 radiology reference article. 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. Cavernous sinus thrombosis cst is the formation of thrombus clot within the cavernous sinus, which can either be septic or aseptic. Cavernous sinus thrombosis is typically a complication of a facial or orbital infection and often presents with proptosis, chemosis, and painful ophthalmoplegia. The infection may spread to involve the cerebrospinal fluid and meninges. The cavernous sinus is one of the several cerebral veins and cavernous sinus thrombosis is a specific type of cerebral venous sinus thrombosis. Highest recanalization rates in deep cerebral veins and cavernous sinus thrombosis, lowest in lateral sinus thrombosis. Pdf mr imaging of cavernous sinus thrombosis researchgate. 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. These clots obstruct the vein in the aforementioned area of your body.
One of the most unusual and grave conditions is cavernous sinus thrombosis cst. See that article for a discussion of the larger clinical entity. 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. 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. Mr imaging of cavernous sinus thrombosis european journal. Prognostic evaluation of cerebral venous sinus thrombosis. The infection in the blood and cerebrospinal fluid are also tested to diagnose the cavernous sinus thrombosis. Based on the affected venous structures, the following subtypes of cvst can be distinguished. Cerebral venous and sinus thrombosis cvst is a rare but important cause of. Current techniques, spectrum of findings, and diagnostic pitfalls. Cavernous sinus thrombosis symptoms, treatment, causes. 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. What is the role of ct scanning in the workup of cavernous. Feb 25, 2018 cerebral venous thrombosis venous sinus thrombosis is caused by clots in the dural venous sinuses and accounts for 0.
The following findings on performing mri are confirmatory for cavernous sinus thrombosis. Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. Treatment and management of venous sinus thrombosis. Cavernous sinus thrombosis eye disorders msd manual. Clinical features and differential diagnosis with mr imaging. The thrombophlebitis can also be located in the 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.
Professor of radiology and biomedical imaging, yale university school of medicine. 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. The filling defect is typically seen on multiple sections in contrastenhanced ct and mr imaging studies. Caroticocavernous fistula radiology reference article. Cavernous sinus thrombosis cst is a rare condition, most commonly infectious in nature, and the diagnosis on imaging is not always straightforward. Surgery is sometimes needed to drain the infection. 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.
In patients with thrombophlebitis of the facial vein, pieces of the clot may break off and enter the cavernous sinus, forming a cavernous sinus thrombosis. Alternatively referred to as cerebral venous sinus thrombosis cvst or dural venous sinus thrombosis dvst, the terms encompass a broad spectrum of neurological pathologies. In current practice, computed tomography ct scan or magnetic resonance imaging mri with contrast is the modality of choice to confirm the. 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. Jul 16, 2018 cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. 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 symptoms, diagnosis and. Diagnostic value of multidetectorrow ct angiography in the. Treatment cavernous sinus thrombosis is treated with highdose antibiotics given through a vein iv if an infection is the cause. Nov 05, 2017 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. Mri is useful to depict cavernous sinus involvement. Computed tomography and magnetic resonance imaging plays an important role in the management of this disease. The cavernous sinus extends posteriorly from the superior orbital fissure to the dorsum sella.
It is mostly caused by an infection with high morbidity and mortality rate. Clinically the diagnosis can be very difficult but modern imaging techniques allow earlier diagnosis and the possibility of early treatment. All statistical analysis was performed using ibm spss software version 22. 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. Treatment and management of venous sinus thrombosis sebastian pollandt, md neurocritical careepilepsy. An awareness of this condition is necessary for early diagnosis and treatment. Cavernous sinus thrombosis is a potentially lifethreatening condition that can happen after an infection in your head.
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. 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. 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. Read more about symptoms, diagnosis, treatment, complications, causes and. 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.
Mr imaging of cavernous sinus thrombosis sciencedirect. It is caused by a bacterial infection that typically originates in the face, sinuses, ears, or orbits 1. It frequently occurs in association with other intracranial complications. 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. Cerebral sinus venous thrombosis pubmed central pmc. On noncontrast ct, thrombosis of the cavernous sinus can be appreciated as increased density. 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. A carotid cavernous fistula ccf is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as. They can be classified as direct or indirect which are separate conditions with different etiologies. Due to diverse clinical presentation of cerebral venous thrombosis it is often under diagnosed.
Septic lateral sinus thrombosis is an infrequent complication of otitis media or mastoiditis and often presents with headaches, fever, otalgia, vertigo, papilledema, and abducens. 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. Cavernous sinus thrombosis is usually a late complication of an infection of the central face or paranasal sinuses. You may also need to participate in a special rehabilitation program or physical therapy, if you have. Imaging signs of cavernous sinus thrombosis include a bulky cavernous sinus, a convex configuration of the lateral wall, and filling defects within the sinus. Cavernous sinus thrombosis cst is a rare condition, defined as a septic thrombophlebitis of the cavernous sinus. After an examination, you may be referred for tests, including a computerised tomography ct scan, a magnetic resonance imaging mri scan and blood tests. The imaging studies also revealed the presence of cavernous sinus thrombosis and carotid septic stenosis. Additional testing for this case included magnetic resonance imaging mri with and without gadolinium. Cerebral venous sinus thrombosis occurs when a blood clot forms in the brains venous sinuses. Imaging characteristics include cavernous sinus expansion, filling defects, restricted diffusion, arterial wall enhancement, empyema, superior. These lesions may arise in the cavernous sinus proper or may secondarily infiltrate the cavernous sinus.
These images are a random sampling from a bing search on the term cavernous sinus thrombosis. 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. Review the imaging findings ct and mri in isolated cortical venous thrombosis icvt. Tributary venosinus occlusion and septic cavernous sinus thrombosis. Cavernous sinus thrombosis cst is a rare and a fulminant lifethreatening. These symptoms usually occur if cavernous sinus thrombosis is left untreated, or if an infection causing the condition spreads throughout the body. Ecr 2017 c2829 10 minutes imaging in acute cerebral venous. Imaging of the cavernous sinus lesions sciencedirect. Tumors of the nasopharynx, skull base, and sphenoid sinus may extend to the cs as can perineural and hematogenous metastases.
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. Cerebral venous sinus thrombosis cvst johns hopkins medicine. Caroticocavernous fistulas ccf represent abnormal communication between the carotid circulation and the cavernous sinus. Imaging lesions of the cavernous sinus american journal of.
Cavernous sinus thrombosis cst is a rare and a fulminant life. Conclusions findings of laboratory tests and magnetic resonance imaging mri confirmed the clinical diagnosis. Ecr 2017 c2829 10 minutes imaging in acute cerebral venous sinus thrombosis by. Imaging lesions of the cavernous sinus american journal. Magnetic resonance imaging mri of the brain magnetic resonance venogram sinus xray. Imaging techniques and laboratory tests are used for diagnosing this condition. Imaging characteristics of cavernous sinus cavernous.
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