Anatomy of cavernous sinus:
From above to downwards, following cranial nerves pass:
Nerve lying closest to the internal carotid artery in cavernous sinus: CN6
Symptoms of cavernous sinus thrombosis:
- Systemic signs of toxemia with high grade fever
- Edema in mastoid region: Pathognomonic sign
- Involvement of V1 & V2: Headache is the MC symptom. The headache is usually sharp, increases progressively, and is usually localized to the regions innervated by the V1 and V2 branches of CN5; accompanied by sensory loss over forehead and chick and impaired corneal reflex.
- Involvement of CN3 & 4: Ophthalmoplegia
- Rapid development of B/L proptosis.
- Involvement of CN6: Loss of abduction (paralysis of LR): 1st sign of B/L cavernous involvement.
- High dose potent broad spectrum IV antibiotics
- Analgesics and anti-inflammatory agents.
It is an abnormal communication between the internal carotid artery and the cavernous sinus following an episode of head trauma.
- Pulsatile proptosis
- Total external ophthalmoplegia.
O/E: Arterial bruit +ve on auscultation
- Small fistula: Balloon tamponade
- Large fistula: Embolization/ Ligation.
More points from anatomy:
Tributaries of cavernous sinus:
|Superior ophthalmic vein
Inferior ophthalmic vein
Central vein of retina
|Superficial middle cerebral vein
Inferior cerebral vein
Draining channels (see above picture):
- Superior petrosal sinus drains cavernous sinus to transverse sinus
- Inferior petrosal sinus drains cavernous sinus into IJV/ Sigmoid sinus
- The 2 cavernous sinuses are connected by anterior and posterior inter-cavernous sinus
- The 2 cavernous sinuses drain into the pterygoid venous plexus through emissary vein (‘E’ in picture).
Tolosa Hunt syndrome:
- Idiopathic inflammatory condition that involves the cavernous sinus
- There is paresis of one or more of the 3rd, 4th and 6th cranial nerve
- C/F: Painful ophthalmoplegia
- MRI: Thickening of cavernous sinus wall
- Rx: Responds rapidly to oral steroids.
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