What Is Cavernous Sinus Thrombosis?
The cavernous sinuses are empty spaces located below the brain, behind the eye sockets. The blood is carried away from the brain through the cavernous sinus by a blood vessel called the jugular vein. A blood clot might develop if an infection in the face or skull reaches the cavernous sinuses. The blood clot is developed to prevent the infection from further spreading. However, it can restrict the blood flow from the brain, which can damage the eyes, brain, and the nerves running between them. Sometimes, clots can develop without infection.
It is difficult to access the exact number of people affected by cavernous sinus thrombosis. However, it is considered a very rare condition. People of all ages are affected by this condition. Cavernous sinus thrombosis occurs more commonly in women than in men. This is seen because pregnancy and oral contraceptive pills can make women more vulnerable to blood clots.
What Are the Symptoms of Cavernous Sinus Thrombosis?
The symptoms of cavernous sinus thrombosis include:
-
A severe and sharp headache, especially around the eye.
-
Fever.
-
Swelling or bulging around the eye and the surrounding tissues.
-
Eye pain.
-
Double vision.
In case of the following cases, the doctor must be consulted immediately:
-
A severe headache that cannot be managed with painkillers or the condition is getting worse.
-
A headache that worsens on lying down or bending.
-
A headache that is unusual and occurs along with blurred vision, problems speaking, weakness, drowsiness, or fits (seizures).
-
Eye pain or swelling of one or both eyes.
-
A rash that looks like tiny bruises or bleeding under the skin.
-
Shortness of breath.
-
Chest pain.
-
Leg swelling or persistent abdominal pain.
The above symptoms rarely occur as a result of cavernous sinus thrombosis; however, these symptoms have to be investigated.
In extremely rare cases, cavernous sinus thrombosis can be seen after having some type of coronavirus vaccine. In such cases, symptoms might appear between four days and four weeks after vaccination. The patient can be referred for tests, like a CT scan, an MRI scan, and blood tests after an examination.
What Are the Risk Factors for Cavernous Sinus Thrombosis?
Risk factors for children and infants include:
-
Certain infections.
-
Disorders leading to problems in blood clot formation.
-
Anemia.
-
Heart disease.
-
Iron deficiency.
-
Dehydration.
-
Head injury.
Risk factors for adults include:
-
Pregnant women and the first few weeks after delivery.
-
Problems with blood clot formation such as protein C and S deficiency, antiphospholipid syndrome, and antithrombin III deficiency.
-
Cancer
-
Collagen vascular diseases.
-
Obesity.
-
Intracranial hypotension (low blood pressure in the brain).
-
Inflammatory bowel diseases like Crohn’s disease or ulcerative colitis.
How Is Cavernous Sinus Thrombosis Treated?
Cavernous sinus thrombosis hospitalization for appropriate treatment. Mostly, the patient is treated in an intensive care unit for proper and close monitoring.
The treatment of cavernous sinus thrombosis includes:
Antibiotics: Antibiotics constitute the major treatment for cavernous sinus thrombosis. Treatment must be initiated as soon as possible, even before the confirmatory test for bacterial infection is positive. If tests reveal that a bacterial infection is not responsible for the condition, antibiotic treatment might be stopped. Antibiotic therapy includes:
-
An anti-staphylococcal agent like Vancomycin if Methicillin resistance is high, or Nafcillin.
-
A third-generation Cephalosporin and Metronidazole for anaerobic organisms
-
Antifungal therapy with Amphotericin B. A prolonged duration of parenteral therapy, usually for three to four weeks or at least two weeks after clinical resolution, is advised.
-
In most cases, the antibiotics are administered for a few weeks to make sure that the infection has been completely treated. The antibiotics are administered through an intravenous drip directly connected to one of the veins. Some patients might experience side effects after taking these antibiotics, including nausea, diarrhea, and a skin rash.
Anticoagulants: Anticoagulants like Heparin are used to help dissolve the clot and prevent the formation of further clots. Certain people might require an anticoagulant tablet for a few months or longer after being discharged from the hospital.
Corticosteroids: In some cases, patients are also given steroid medications or corticosteroids. They help to reduce inflammation and swelling in the body.
Surgical Drainage: If the symptoms of cavernous sinus thrombosis, caused by an infection, spread from a boil or sinusitis, it is necessary to drain the pus away from that site. This can be performed either by using a needle or during surgery.
The antibiotics have to be administered for several weeks. However, it can take longer to achieve complete recovery, and it might be several months before the patient is well enough to leave the hospital.
What Are the Complications Associated With Cavernous Sinus Thrombosis?
Cavernous sinus thrombosis is a severe condition. Even with immediate treatment, one out of three people with this condition might die. Some patients who survive might develop long-term health issues due to damage to their brain, like persistent headaches and fits or some amount of vision loss.
How Is Cavernous Sinus Thrombosis Diagnosed?
Patients who have experienced any kind of stroke show the best recovery if immediate treatment is initiated. Doctors usually require a medical history and perform a physical exam. If the patient is unconscious, the symptoms can be described by the family and friends. However, the final diagnosis is usually made based on how the blood flows in the brain. Imaging tests are used to locate areas of blood flow. The following tests can be employed to diagnose venous sinus thrombosis:
-
Magnetic resonance imaging (MRI) scan.
-
Computed tomography (CT) scan.
-
Venography (an X-ray technique showing blood flow in the veins).
-
Angiography (a medical imaging technique that shows inside a blood vessel).
-
Ultrasound.
-
Blood tests.
Conclusion:
Infection can spread through the jugular vein to the pulmonary vasculature leading to septic emboli or abscesses, pneumonia, or empyema. Stroke can also cause vasculitis, carotid artery narrowing, or hemorrhagic infarction after progression to cortical vein thrombosis. Hypopituitarism might also occur due to ischemia or the spread of infection directly. Cavernous sinus thrombosis can result in various complications involving the central nervous system or infectious pulmonary. Since there are no valves in the dural venous and the cavernous system, the venous blood can reach the dural sinuses and cerebral and emissary veins, leading to brain abscess, meningitis, or dural empyema.
