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Wednesday, February 2, 2011

CAVERNOUS SINUS THROMBOSIS

This uncommon condition occurs as a complication of a septic focus over face, orbit, nose, teeth etc. The infection spreads from facial veins to ophthalmic vein and finally to the cavernous sinus. Intracranial extension may be accompanied by meningitis.


Clinical features
These include high spiking fever, rigors, drowsiness, swelling of affected eye with proptosis, chemosis, prominent veins over lids and opthalmoplegia involving 3rd, 4th, 5th and 6th cranial nerves. Pupillary reflexes may be absent and there may be visula defects with, at times, total blindness. Fundoscopy reveals blurred disc margins and engorged retinal veins.


Diagnosis
It is more or less clinical, Orbital cellulitis with localized manifestations is an important differential diagnosis. LP is indicated in a case of doubtful meningitis. Slight rise in CSF proteins may be seen in cavernous sinus thrombosis without meningitis.

Treatment
It consists in giving high dose parenteral antibiotic therapy, providing a good cover for staphylococcus aureus, and anti-inflammatory therapy. Drainage of pus from primary septic focus needs to be given a priority.
Supportive measures, including mannitol for raised intracranial tension, are indicated.
Anticoagulant therapy is no longer recommended

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