Septic thrombosis of the cavernous sinuses
M. J. DiNubile
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Department of Medicine, Cooper Hospital/University Medical Center, Camden 08103.
Cavernous sinus thrombosis may occur as a complication of infectious and
noninfectious processes. Septic thrombosis of the cavernous sinuses most
commonly follows infections of the middle third of the face due to
Staphylococcus aureus. Other antecedent sites of infection include
paranasal (usually sphenoid) sinusitis, dental abscess and, less often,
otitis media. Fever is a nearly constant finding, but headache may not be
prominent. Periorbital edema, chemosis, proptosis, and limitation of
extraocular movements (especially lateral gaze) develop in almost all
recognized cases. Involvement of the opposite eye frequently appears within
two days following the onset of unilateral signs. Although computed
tomography may be helpful, magnetic resonance imaging is probably the
diagnostic procedure of choice. Treatment includes appropriate antibiotics
and, oftentimes, surgical drainage of the primary focus of infection. Less
than half of the patients recover completely; the mortality rate is
approximately 30%.
