What are the signs of cavernous sinus thrombosis (CST)?

Updated: Jul 16, 2018
  • Author: Rahul Sharma, MD, MBA, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Other than the findings associated with the primary infection, the following signs are typical for cavernous sinus thrombosis:

Periorbital edema may be the earliest physical finding.

  • Chemosis results from occlusion of the ophthalmic veins.

  • Lateral gaze palsy (isolated cranial nerve VI) is usually seen first since CN VI lies freely within the sinus in contrast to CN III and IV, which lie within the lateral walls of the sinus. [3]

  • Ptosis, mydriasis, and eye muscle weakness from cranial nerve III dysfunction

Manifestations of increased retrobulbar pressure follow.

Signs of increased intraocular pressure (IOP) may be observed.

  • Pupillary responses are sluggish.

  • Decreased visual acuity is common owing to increased IOP and traction on the optic nerve and central retinal artery.

Hypoesthesia or hyperesthesia in dermatomes supplied by the V1 and V2 branches of the fifth cranial nerve.

Appearance of signs and symptoms in the contralateral eye is diagnostic of CST, although the process may remain confined to one eye.

Meningeal signs, including nuchal rigidity and Kernig and Brudzinski signs, may be noted.

Systemic signs indicative of sepsis are late findings. They include chills, fever, shock, delirium, and coma.


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