Cavernous sinus thrombosis:
Intracranial venous thrombosis is a special type of cerebrovascular disease, which can be divided into venous sinus thrombosis and cerebral venous thrombosis. According to its pathological nature, it can be divided into inflammatory and non-inflammatory types. According to its anatomical location, it can be divided into cavernous sinus thrombosis, superior sagittal sinus thrombosis, sigmoid sinus thrombosis, etc. Among them, the clinical manifestations of superior sagittal sinus thrombosis are different from those of traditional stroke diseases, while the other lesions show varying degrees of stroke symptoms.
The cavernous sinus is a part of the dural venous sinuses, which receives the blood returned from the middle cerebral veins and the inferior cerebral veins. Cavernous sinus thrombosis is mostly caused by bacterial infections in the head and face, and occasionally occurs in a few patients due to head trauma and severe dehydration. After thrombosis forms, widespread facial paralysis on one side occurs rapidly, which is similar to the meridian symptoms in stroke diseases, but without limb motor dysfunction.
After the formation of a cavernous sinus thrombosis, most patients experience a sudden onset of fever, accompanied by headache, nausea, vomiting, orbital congestion, and protrusion of the eyes. The facial nerves, including the oculomotor, trochlear, trigeminal, and abducens nerves, become paralyzed, resulting in immobility of the eyes, ptosis of the upper eyelid, inability of the orbicularis oculi muscle to contract, incomplete or insufficient outward movement of the eyes, diplopia (double vision) when looking at objects, and numbness or loss of pain, temperature, and humidity sensation on one side of the face.
One significant feature of this disease is that after a unilateral lesion, it can spread to the contralateral side, forming bilateral thrombosis, and the paralysis of the facial nerves also presents bilateral symptoms. A lumbar puncture for cerebrospinal fluid (CSF) examination can reveal increased pressure, red and white blood cells, and a positive CSF culture.
What are the treatment principles for cavernous sinus thrombosis?
Given that cavernous sinus thrombosis is often caused by bacterial inflammation in the head and face, active treatment of bacterial infections in these areas is essential. Simultaneously, administration of large doses of antibiotics is recommended, preferably selected based on the results of CSF bacterial culture. Hormone therapy, such as hydrocortisone or dexamethasone, can also be used. After the formation of a cavernous sinus thrombosis, the function of eye movement is weakened or lost, the orbicularis oculi muscle becomes paralyzed, and the conjunctiva and cornea are prone to infection. Therefore, antibacterial ointment should be applied to the eyelids, and eye protection is necessary.
