Cavernous Sinus Thrombosis

Cavernous sinus thrombosis (CST) is a rare and fulminant life-threatening disorder. Early identification of CST, which is usually characterized by ocular symptoms such as fever, headache, periocular swelling, and paralysis, is essential for a good prognosis.

Microbiology of CST

The microbiology of CST is well documented. Bacteria stimulate the formation of a thrombus by releasing coagulants and toxins. Sinusitis appears to be the most common cause of infection with CST. Sphenoid sinusitis is a rare major source of infection. However, it is also seen in other cases of sinus infections, especially ethmoid sinusitis. Sinusitis is caused by Streptococcus species, including S pneumoniae, and S aureus, gram-negative bacteria, and anaerobic bacteria. In cases of facial boils, Saureus is the most common organism, followed by the Streptococcus species.

Pathophysiology of CST

The etiology of CST is infectious or sterile. Causes of asepsis usually occur after surgery and trauma. Causes of infection include sinusitis, otitis, odontogenic sources, facial furuncles, and erysipelas.

Most commonly, CST is secondary to transmission and direct extension of venous infection. Diffusion can occur through the spread of thrombus and/or septic embolism. The infection spreads anterograde through the ophthalmic vein and the horny vein, leading to the classic clinical appearance of periorbital edema. Retrograde diffusion can also occur through the messenger vein, which connects the pterygial plexus, and this tends to be a slower and more insidious progression.

Diagnosis of CST

The best diagnostic method is neuroimaging using contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The use of cerebral angiography or orbital venography has been reported; however, these techniques have the potential for serious complications, including the dissemination of infection.

Imaging helps in identifying thrombosis either via direct visualization of the thrombus/filling defect in the cavernous sinus or via indirect signs that include proptosis, dilatation of the draining tributaries, and abnormal dural enhancement, that are well demonstrated in contrast enhanced studies.

Fig.1 Diagrammatic illustration of the coronal section of the cavernous sinus anatomy showing. (Bhatia, 2020)

Treatment

In general, antimicrobial and antithrombotic treatments are the primary consideration. Antimicrobial therapy includes an anti-staphylococcal drug, a third-generation cephalosporin, metronidazole as well as antifungal therapy with amphotericin B. Studies have shown that the use of antimicrobial agents in combination with anticoagulants for septic CST reduces mortality from 40% to 14% and neurological morbidity from 61% to 31%. In addition, corticosteroids are usually given but have not been proven effective. The potential benefits are reduced inflammation and vasogenic edema around cranial nerves and orbital structures.

Besides, many companies and organizations have generated a wide spectrum of CST-related products or neuroscience research tools, such as Neural Proteins & Peptides, Neural Antibodies, Neural Cell Lines, as well as Animal Models to reveal the molecular basis for CST cause, diagnosis, and treatment.

Creative Biolabs focuses on neuroscience research and has extensive experience in disease improvement projects. We can develop the necessary analytics specific to your cavernous sinus thrombosis project and provide timely and effective solutions to any challenges you face. Please contact us for more details.

Reference

1. Bhatia, H.; et al. MR imaging of cavernous sinus thrombosis. Eur J Radiol Open. 2020 Mar 3; 7: 100226.