Cavernous sinus thrombosis - Revision history

Rossdonaldson1: /* Background */

2022-12-07T19:59:19Z

Background

← Older revision		Revision as of 19:59, 7 December 2022
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	==Background==		==Background==
			[[File:Gray571.png\|thumb\|Oblique section through the cavernous sinus.]]
	*Severe infection involving complications of paranasal sinus and facial infections (e.g. manipulated midface abscesses, furuncles)		*Severe infection involving complications of paranasal sinus and facial infections (e.g. manipulated midface abscesses, furuncles)
	*Frequent extension of thrombosis to opposite sinus		*Frequent extension of thrombosis to opposite sinus

Zbuchwald: /* Disposition */

2022-11-29T06:56:09Z

Disposition

← Older revision		Revision as of 06:56, 29 November 2022
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	==Disposition==		==Disposition==
	*Consult ophthalmology, neurology, ID, surgery ~~specialty (if drainage is needed~~) ~~and admit~~ ICU		*Consult ophthalmology, neurology, ID, and ENT (or other appropriate surgery subspecialty)
			*Admit to ICU

	==Complications==		==Complications==

Zbuchwald: /* Evaluation */

2022-11-29T06:54:58Z

Evaluation

← Older revision		Revision as of 06:54, 29 November 2022
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	*[[brain MRI\|MRI]] with MR Venogram - study of choice		*[[brain MRI\|MRI]] with MR Venogram - study of choice
	*[[CT head]] Venogram acceptable choice if no MR available with 95% sensitivity <ref> Chiewvit P, Piyapittayanan S, Poungvarin N. Cerebral venous thrombosis: diagnosis dilemma. Neurol Int. 2011 Nov 29;3(3):e13. doi: 10.4081/ni.2011.e13. Epub 2011 Dec 15. PMID: 22368772; PMCID: PMC3286153. </ref>		*[[CT head]] Venogram acceptable choice if no MR available with 95% sensitivity <ref> Chiewvit P, Piyapittayanan S, Poungvarin N. Cerebral venous thrombosis: diagnosis dilemma. Neurol Int. 2011 Nov 29;3(3):e13. doi: 10.4081/ni.2011.e13. Epub 2011 Dec 15. PMID: 22368772; PMCID: PMC3286153. </ref>
	**CT findings can be subtle and if clinical suspicion is high cannot rule out ~~if neg~~ CT		**CT findings can be subtle and if clinical suspicion is high cannot rule out with a negative CT
	*Blood cultures		*Blood cultures

Zbuchwald: /* Evaluation */

2022-11-29T06:54:31Z

Evaluation

← Older revision		Revision as of 06:54, 29 November 2022
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	==Evaluation==		==Evaluation==
	*[[brain MRI\|MRI]] with MR Venogram - study of choice		*[[brain MRI\|MRI]] with MR Venogram - study of choice
	*[[CT head]] Venogram acceptable choice if no MR available <ref> Chiewvit P, Piyapittayanan S, Poungvarin N. Cerebral venous thrombosis: diagnosis dilemma. Neurol Int. 2011 Nov 29;3(3):e13. doi: 10.4081/ni.2011.e13. Epub 2011 Dec 15. PMID: 22368772; PMCID: PMC3286153. </ref>		*[[CT head]] Venogram acceptable choice if no MR available with 95% sensitivity <ref> Chiewvit P, Piyapittayanan S, Poungvarin N. Cerebral venous thrombosis: diagnosis dilemma. Neurol Int. 2011 Nov 29;3(3):e13. doi: 10.4081/ni.2011.e13. Epub 2011 Dec 15. PMID: 22368772; PMCID: PMC3286153. </ref>
	**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT		**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT
	*Blood cultures		*Blood cultures

Zbuchwald: /* Evaluation */

2022-11-29T06:53:38Z

Evaluation

← Older revision		Revision as of 06:53, 29 November 2022
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	==Evaluation==		==Evaluation==
	*[[brain MRI\|MRI]] with MR Venogram - study of choice		*[[brain MRI\|MRI]] with MR Venogram - study of choice
	*[[CT head]] Venogram acceptable choice if no MR available		*[[CT head]] Venogram acceptable choice if no MR available <ref> Chiewvit P, Piyapittayanan S, Poungvarin N. Cerebral venous thrombosis: diagnosis dilemma. Neurol Int. 2011 Nov 29;3(3):e13. doi: 10.4081/ni.2011.e13. Epub 2011 Dec 15. PMID: 22368772; PMCID: PMC3286153. </ref>
	**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT		**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT
	*Blood cultures		*Blood cultures

Zbuchwald: /* Evaluation */

2022-11-29T06:52:00Z

Evaluation

← Older revision		Revision as of 06:52, 29 November 2022
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	==Evaluation==		==Evaluation==
	*[[brain MRI\|MRI]] with MR Venogram - study of choice		*[[brain MRI\|MRI]] with MR Venogram - study of choice
	*[[CT head]]~~/orbits with IV contrast~~		*[[CT head]] Venogram acceptable choice if no MR available
	**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT		**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT
	*Blood cultures		*Blood cultures

Elcatracho: /* Clinical Features */

2021-01-13T17:06:56Z

Clinical Features

← Older revision		Revision as of 17:06, 13 January 2021
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	**Decreased EOM secondary to CN III, IV, VI		**Decreased EOM secondary to CN III, IV, VI
	***[[abducens nerve palsy\|CN VI]] typically affected 1st causing lateral gaze palsy		***[[abducens nerve palsy\|CN VI]] typically affected 1st causing lateral gaze palsy
			***CN VI palsy and [[Horner Syndrome]] known as Parkinson sign<ref>Harris FS and Rhoton, Jr. AL. Anatomy of the cavernous sinus: A microsurgical study. Journal of Neurosurgery. 1976; 45: 169-180.</ref>
	**Decreased corneal sensation secondary to CN V		**Decreased corneal sensation secondary to CN V
	*If infection spreads into CNS: altered mental status, lethargy, meningeal signs		*If infection spreads into CNS: altered mental status, lethargy, meningeal signs

ClaireLewis at 00:34, 2 October 2019

2019-10-02T00:34:11Z

← Older revision		Revision as of 00:34, 2 October 2019
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	==Clinical Features==		==Clinical Features==
	*Fevers, chills~~, nausea and~~ vomiting~~, headache~~		*[[Fevers]]/chills
			*[[Nausea/vomiting]]
			*[[Headache]]
	*Eye exam		*Eye exam
	**infraorbital/periorbital cellulitis		**infraorbital/periorbital [[cellulitis]]
	**Exophthalmos (uni~~/bl~~)		**Exophthalmos (uni or bilateral)
	**Decreased vision		**[[vision loss\|Decreased vision]]
	**Absent pupillary reflexes		**Absent pupillary reflexes
	**Decreased EOM secondary to CN III, IV, VI		**Decreased EOM secondary to CN III, IV, VI
	***CN VI typically affected 1st causing lateral gaze palsy		***[[abducens nerve palsy\|CN VI]] typically affected 1st causing lateral gaze palsy
	**Decreased corneal sensation secondary to CN V		**Decreased corneal sensation secondary to CN V
	*If infection spreads into CNS: altered mental status, lethargy, meningeal signs		*If infection spreads into CNS: altered mental status, lethargy, meningeal signs
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	==Evaluation==		==Evaluation==
	*MRI with MR Venogram - study of choice		*[[brain MRI\|MRI]] with MR Venogram - study of choice
	*CT head/orbits with IV contrast		*[[CT head]]/orbits with IV contrast
	**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT		**CT findings can be subtle and if clinical suspicion is high cannot rule out if neg CT
	*Blood cultures		*Blood cultures
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	==Management==		==Management==
	*IV antibiotics:		*IV antibiotics:
	**3rd generation cephalosporin ~~and~~:		**3rd generation [[cephalosporin]] AND:
	**Nafcillin or vancomycin/linezolid if suspected MRSA and <br>		**[[Nafcillin]] or [[vancomycin]]/[[linezolid]] if suspected MRSA and <br>
	**Anaerobic coverage if suspected dental source		**Anaerobic coverage if suspected dental source
	*Consider heparin if rapidly decompensating and CT negative for intracranial hemorrhage		*Consider [[heparin]] if rapidly decompensating and CT negative for intracranial hemorrhage
	*Consider steroids to decrease inflammation in conjunction with antibiotics		*Consider [[steroids]] to decrease inflammation in conjunction with antibiotics
	*Surgical drainage of primary infection if possible		*Surgical drainage of primary infection if possible

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	*Septic emboli		*Septic emboli
	*Remaining visual defects		*Remaining visual defects
	*CNS deficit		*[[focal neuro deficits\|CNS deficit]]
	*[[Adrenal Crisis\|pituitary insufficiency]]		*[[Adrenal Crisis\|pituitary insufficiency]]

Mholtz: Text replacement - "==Treatment==" to "==Management=="

2017-12-07T15:06:02Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 15:06, 7 December 2017
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	*Blood cultures		*Blood cultures

	==~~Treatment~~==		==Management==
	*IV antibiotics:		*IV antibiotics:
	**3rd generation cephalosporin and:		**3rd generation cephalosporin and:

Iwm5010: /* Treatment */

2017-11-27T17:01:28Z

Treatment

← Older revision		Revision as of 17:01, 27 November 2017
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	**Nafcillin or vancomycin/linezolid if suspected MRSA and <br>		**Nafcillin or vancomycin/linezolid if suspected MRSA and <br>
	**Anaerobic coverage if suspected dental source		**Anaerobic coverage if suspected dental source
	*Consider heparin if rapidly decompensating and CT ~~neg~~ for intracranial hemorrhage		*Consider heparin if rapidly decompensating and CT negative for intracranial hemorrhage
	*Consider steroids to decrease inflammation in conjunction with antibiotics		*Consider steroids to decrease inflammation in conjunction with antibiotics
	*Surgical drainage of primary infection if possible		*Surgical drainage of primary infection if possible