Cavernous Sinus is a large collection of thin walled veins creating a cavity bordered by sphenoid bone and the temporal bone of the skull (Andersson, Kahnberg, and Pogrel 555). It lies within the skull, found behind each orbit, and contains cranial nerve III, cranial nerve IV, ophthalmic and maxillary nerves. The core function of the Cavernous Sinus is to drain blood from the brain, back to the heart (Andersson, Kahnberg, and Pogrel 555). In light with this, Cavernous Sinus Thrombosis (CST) is a thrombophlebitis cavernous sinus, caused by the blockage of a large vein within the Cavernous Sinus due to the formation of a blood clot (Stucker et al. 291).
The key causation of CST is sinusitis, an infection, which may retrograde, spreading through the superior or inferior ophthalmic veins into the cavernous sinus, amounting to a life threatening septic thrombophlebitis (Stucker et al. 291). In tandem to this, Stucker still asserts that CST may also result from aseptic sources or any other source (291). Further, infections of the central facial section also referred to as danger triangle, can result to CST ascribed to valveless venous drainage within the region (Stucker et al. 291). The spread of the infection can either be orbital or intracranial depending on the setting of the sinus infection (Stucker et al. 291). In orbital spread, the infection spreads from the paranasal sinuses, to the ears, nose, eyes, or skin of the face (Andersson, Kahnberg, and Pogrel 555). On the other hand, intracranial spread of sinus, originates from frontal or sphenoid sinusitis. Patients with CST may present acute clinical picture accompanied with headaches, stupor, fever, face swelling, visual disturbance, vomiting and affected mental status. Presentation of signs of meningitis and multiple cranial nerve palsies bilaterally may also signify an extreme CST infection (Duncavage and Becker 27).
Apart from the clinical presentation, the imaging of the studies; sinus radiography, computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI), aid in the diagnosis of CST (Andersson, Kahnberg, and Pogrel 555). In addition to this, unilateral or bilateral palsles of cranial nerves III, IV, and VI, ptosis, chemosis, and proptosis constitute the vital facets that aid in the identification of CST (Greenberg et al. 49). Also, differential diagnosis can be used in the identification of CST.
The most common bacterium found in CST is Staphylococcus aureus, and thence, it underscores the urge for broader antibiotic coverage and adequate coverage for the possibility of methicillin-resistant, Staphylococcus aureus (Stucker et al. 291). Moreover, the addition of anticoagulant, heparin to the regimen to reduce or prevent further propagation of the thrombus, can also act as a source of treatment (Stucker et al. 291). Other forms of treatment may include non-pharmacological treatment, which entails treatment of the primary sources of infections that amount to CST. Similarly, emergency surgical drainage is utterly fundamental at the primary site of infection (Greenberg et al. 49). In addition, steroid therapy also offers a suitable method to the treatment of CST (Greenberg et al. 49). However, steroid therapy and anticoagulation with heparin remain under controversial. The use of anticoagulant may trigger septic emboli and increase the risk for intracranial bleeding, resulting to death (Stucker et al. 291).
Appropriate management of CST can reduce the mortality rate, however, if left untreated, the mortality rate are likely to be high (Greenberg et al. 49). Besides, nonfatal complications may be experienced, and they may constitute permanent ophthalmoplegia, hemiparesis, and pituitary insufficiency (Greenberg et al. 49). In line with this, patients with CST may lose vision ascribed to secondary corneal exposure or corneal ulceration that results from severe proptosis or neurotrophic keratopathy caused by trigeminal sensory neuropathy (Miller et al. 2625). Visual loss may also result from ischemic arteries caused by blockage of the ophthalmic arteries (Miller et al. 2625).
Concisely, CST is a disease that affects the Cavernous Sinus section of the brain due to bacterial infection. The disease is extremely detrimental as it can result to lose of vision and even death if not managed properly. Proper treatment and management are also hugely indispensable, since they aid in curbing, other infections or diseases associated with CST, as well as death.
Work Cited
Andersson Lars, Karl-Erik Kahnberg, and Anthony Pogrel. Eds. Oral and Maxillofacial Surgery. Iowa: Blackwell Publishing Ltd, 2010. Print
Duncavage, A. James, and Samuel S. Becker. The Maxillary Sinus: Medical and Surgical Management. New York, NY: Thieme Medical Publishers, Inc, 2011. Print.
Greenberg, I. Michael et al. Eds. Greenberg's Text-Atlas of Emergency Medicine. Philadelphia, PA: Lippincott Williams & Wilkins, 2005. Print.
Miller, R. Neil et al. Eds. Walsh and Hoyt's clinical Neuro-Ophthalmology, Volume 3. Philadelphia, PA: Lippincott Williams & Wilkins, 2005. Print.
Stucker, J. Fred. Rhinology and Facial Plastic Surgery. Eds. Stucker, J. Fred et al. New York, NY: Springer, 2009. Print.
