We conducted the current study to identify clinical and imaging features that allow a reliable approach to the etiologic diagnosis of patients with css. Paired venous sinus, on either side of body of sphenoid. Traversed by numerous trabeculae, dividing it into a several caverns spaces, hence cavernous sinus relations. Mri with contrast is the imaging modality of choice to confirm its presence and to differentiate it from alternatives such as orbital cellulitis, which may have a similar clinical presentation. Cavernous sinus thrombosis radiology reference article. Cavernous sinus definition of cavernous sinus by medical. The most common are neurogenic tumors and cavernoma. Nothing demonstrates the limits of anatomical plasticity quite like pathology. Cavernous sinus syndromes refer to constellations of clinical signs and symptoms referable to pathology within or adjacent to the cavernous sinus. In 5 patients with cushing syndrome, cavernous sinography was performed to assess drainage pattern of the cs. Sampling was performed from the anterior, middle, and posterior parts of the cs, inferior petrosal sinus ips, and the peripheral vein. Treatment with endovascular occlusion has been attempted with some success. Clinical presentation patients present with multiple unilateral cranial neuropathies involving an.
To access free multiple choice questions on this topic, click here. Cavernous sinus synonyms, cavernous sinus antonyms. Cavernous sinus syndrome is characterized by lesions that affect multiple cranial nerves within the cavernous sinus. The cavernous sinus cs is not a venous plexus, but it is a true dural venous sinus. To characterize lesions causing cavernous sinus syndrome. Owing to the fact that there are no valves in the sinus and its connected veins, the direction of blood flow is dependent on venous pressure. Cavernous sinus thrombosis is a lifethreatening complication that may rarely result from infection spreading back through the emissary veins from the maxillary or nasal region, or upper teeth, or from infected thrombi in the anterior facial vein or less commonly the pterygoid plexus. Cavernous sinus syndrome css is a condition characterized by multiple cranial nerve palsies manifesting with ophthalmoplegia, ptosis, and facial sensory loss due to involvement of adjacent cranial nerves.
A condition characterized by swelling of the eyelids and the conjunctivae of the eyes, as well as paralysis of the cranial nerves that course through the cavernous sinus. Definition of cavernous sinus syndrome medicinenet. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. A malignant melanoma had been excised from his right forearm in 2003, with negative sentinel axial lymph node biopsy. Cavernous sinus neoplasms cavernous sinus tumors are the most common cause of cavernous sinus sindrome. Cavernous sinus tumours are the most common cause of the cavernous sinus syndrome. Management comprises appropriate antibiotic treatment supplemented by anticoagulation to prevent septic emboli, steroids to reduce oedema, and surgery to. The cavernous sinus cs has one of the most complex anatomical networks of the skull base and because of the diversity of its contents is involved in many pathological processes.
A 67yearold white man presented, in 2010, with 6 weeks of double vision and leftsided periorbital pain with altered sensation. Cavernous sinus syndrome select 5minute pediatrics topics. These may be metastatic from lung, breast, prostate, etc, result from local spread nasopharyngeal, pituitary, craniopharyngioma, or be primary tumours meningioma, neurofibroma. Cavernous sinus connections demonstrated by cavernous sinus dural fistula. In cavernous sinus thrombosis, ocular signs dominate the clinical picture with orbital pain, chemosis, proptosis, and septic dural sinus thrombosis view in chinese suggest early heparinization in patients with unilateral cavernous sinus thrombosis. Cavernous sinus syndrome describes symptoms comprising ophthalmoplegia, chemosis, proptosis, horner syndrome, andor trigeminal sensory loss evoked by vascular, inflammatory, traumatic, congenital, or neoplastic processes affecting the cavernous sinus near the midline of the frontotemporal part at the base of the skull. These signs and symptoms result from the involvement of the cranial nerves passing through the cavernous sinus.
Review of 26 years of personal experience in a large city hospital. Cavernous sinus syndrome is characterized by multiple cranial neuropathies. Early diagnosis and treatment of css play a key role in a better. The clinical presentation typically consists of various combinations of ocular motor nerve impairments oculomotor nerve cn iii, trochlear nerve cn iv, and abducens nerve cn vi, horner syndrome, and sensory loss of the. The dural sinuses are grouped into the sagittal, lateral including the transverse, sigmoid, and petrosal sinuses, and cavernous sinuses. Among 151 patients, tumors 45 patients, 30% were the most frequent cause of cavernous sinus syndrome.
An abnormally growing pituitary adenoma, sitting on the bony sella turcica, will expand in the direction of least resistance and eventually compress the cavernous sinus. Syndromes of the orbital fissure, cavernous sinus, cerebello pontine. Cavernous sinus syndrome cavernous sinus structure. Cavernous sinus syndrome definition of cavernous sinus. Cavernous sinus syndrome and headache due to bilateral. Jefferson syndrome cavernous sinus syndrome css is defined by signs and symptoms see cavernous sinus. Mar 21, 2020 cavernous sinus syndrome is a broad category of pathology that is often difficult to diagnose or define but can encompass damage to the ocular nerves andor the pupil, bloodshot conjunctiva, a reddening in parts of the face, changes in facial sweating, and other symptoms associated with horners syndrome.
An 89yearold woman with a history of hypertension and paget disease had a severe throbbing rightsided headache. Cavernous sinus syndrome may result from mass effect of these tumors and cause ophthalmoplegia from compression of the oculomotor nerve, trochlear nerve, and abducens nerve. Jul 16, 2018 cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. The majority of patients present with unilateral orbital pain and features suggestive of paralysis of one or more of the cranial nerves passing through the cavernous sinus andor superior orbital fissure. The veins that communicate with the cavernous sinus are. The technique of choice for study is mri, although ct can help recognize and identify some anomalies, such as bone destruction. A pair of cavernous sinus, on either side of sella turcica. There are numerous diseases evoking cavernous sinus syndrome. Pdf cavernous sinus syndrome css is a rare condition.
Cavernous sinus syndromes statpearls ncbi bookshelf. Mar 27, 2015 cavernous sinus syndrome css is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and horners syndrome. Cavernous sinus syndrome css is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and horners syndrome. Introduction in 1734, in a book named an anatomical exposition of the structure of the human body by james benignus winslow 16691770 began the first and only usage of the term cavernous sinus, thinking that it resembled corresponding author. The superior orbital fissure syndrome proptosis, fixed dilated pupil and limitation of eye movements. Cavernous sinus thrombosis is a very rare, lifethreatening condition that can affect adults and children in cavernous sinus thrombosis, a blood clot blocks a vein that runs through a hollow. Syndromes of the orbital fissure, cavernous sinus, cerebello. The impact of cavernous sinus drainage pattern on the results. Pdf cavernous sinus syndrome css is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal. Inflammatory cavernous sinus syndromes may respond to treatment of the specific systemic inflammation or vasculitis. Request pdf cavernous sinus syndrome the progress in the understanding of central nervous system cns and skull base infections, is tremendous and it is more so in the case of fungal.
The oculomotor, trochlear, ophthalmic and maxillary divisions of the trigeminal nerve, and the abducens nerve run through the cavernous sinus, as does. Aug 20, 2015 tolosahunt syndrome, an idiopathic granulomatous inflammation of the cavernous sinus, is primarily a diagnosis of exclusion. Cavernous sinus definition of cavernous sinus by the free. Because of the close relationships among the cranial nerves in the vicinity of the cavernous sinus, lesions in this region may cause various multiple cranial nerve. Tumors of the nasopharynx, skull base, and sphenoid sinus may extend to the cs as can perineural and hematogenous metastases.
What better way to show all available cavernous sinus connections than a highpressure cavernous sinus state, exemplified by the various complex and challenging fistulas which afflict it. Tumors, trauma, and vascular, infectious, and noninfectious inflammatory disorders have all. Parasellar syndrome cavernous sinus syndrome the cavernous sinus is a true dural venous sinus that is bordered by the temporal bone and the sphenoid bone, and lies lateral to the sella turcica. Jun 12, 20 cavernous, sinus, anatomy, cavernous, sinus, syndrome, neurology, anatomy, physiology, symptoms, findings, causes, mnemon. We report the case of a 53yearold man with a history of daily stabbing headache associated with.
Case report cavernous sinus syndrome in a patient with sinonasal. Cavernous sinus syndrome with pachymeningitis practical. Synonyms for cavernous sinus syndrome in free thesaurus. The patient recovered well after treatment, exhibiting free extraocular. Cavernous sinus syndrome, fungal sinusitis, aspergillosis. Cavernous sinus thrombosis is a clinical diagnosis. Transsphenoidal surgery is the preferred treatment for most kinds of pituitary. Cavernous sinus contents mnemonic radiology reference. The acute development of a cavernous sinus syndrome with associated cranial nerve deficits in conjunction with an aneurysm entirely encased within a neoplastic lesion supports the diagnosis of an acutely enlarging pseudoaneurysm, and we describe the first reported use of endovascular flow diversion therapy in such a setting. O tom cat consider a coronal view of the cavernous sinus.
Departmental guidelines anatomy cavernous sinus 2cm in length, height of 1cm paired venous sinus, on either side of body of sphenoid. The cavernous sinus is an unconventional venous system in the sense that it does not have a unidirectional flow of blood. There was an incomplete third nerve palsy and altered sensation in the first and second trigeminal dermatomes. The etiology of cavernous sinus syndrome css remains difficult to determine in spite of the development of neuroimaging techniques. Cavernous sinus thrombosis an overview sciencedirect topics. Cavernous sinus syndrome synonyms, cavernous sinus syndrome. Cavernous sinus syndrome radiology reference article. Cavernous sinus thrombosis article about cavernous sinus. The clinical presentation includes impairment of ocular motor nerves, horners syndrome, and sensory loss of the first or second divisions of the trigeminal nerve in various combinations.
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