Cavernous sinus thrombosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Cavernous sinus thrombosis must be differentiated from other diseases that cause severe headache, pain with eye movements, high fever, proptosis, periorbital swelling, and ophthalmoplegia, such as orbital cellulitis, acute Angle-Closure Glaucoma, intracranial tumors and, carotid cavernous fistula and tolosa-Hunt syndrome.

Differentiating cavernous sinus thrombosis] from other Diseases

Cavernous sinus thrombosis must be differentiated from other diseases that cause severe headache, pain with eye movements, high fever, proptosis, periorbital swelling, and ophthalmoplegia, such as orbital cellulitis, acute Angle-Closure Glaucoma, intracranial tumors and, carotid cavernous fistula and tolosa-Hunt syndrome.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]

Diseases Clinical manifestations Para-clinical findings Additional findings
Symptoms Physical examination
Lab Findings
Severe headache High fever Pain with eye movements Proptosis Periorbital swelling and redness in one or both eyes Ophthalmoplegia Elevated ESR and CRP Positive blood culture Neutrophilic-predominant leukocytosis
Cavernous sinus thrombosis ++ ++ ++ ++ ++ ++ ++ ++ ++
Orbital cellulitis + + +++ +++ +++ ++ ++ + +
  • It may be acute or chronic.
  • May lead to cavernous sinus thrombosis.
Acute Angle-Closure Glaucoma +++ _ ++ _/+ _ _ _ _ _
Tumors such as: + _ _/+ _/+ _ ++ _/+ _ _/+ In most cases of intracranial tumors the symptoms progression is not fast.
Lytic bone lesions near the sphenoid sinus or sella turcica + _ _ _ _ ++ _ _ _ Slow progression in most cases
Carotid cavernous fistula + _ + + _/+ _/+ _ _ _
  • Patients usually present with sudden or insidious onset of redness in one eye, associated with progressive proptosis or bulging
  • Bruit (a humming sound within the skull due to high blood flow through the arteriovenous fistula) may be heard
Cavernous hemangioma + _ + + _/+ _/+ _ _ _
  • Cavernous hemangioma is found in women more frequently than men, most commonly between the ages of 20-40
Tolosa-Hunt syndrome + _ + _/+ _ + _ _ _/+ Symptoms are usually limited to one side of the head, and in most cases the individual affected will experience intense, sharp pain and paralysis of muscles around the eye

References

  1. ↑ Clifford-Jones RE, Ellis CJ, Stevens JM, Turner A (1982). "Cavernous sinus thrombosis". J Neurol Neurosurg Psychiatry. 45 (12): 1092–7. PMC 491689. PMID 7161604.
  2. ↑ Arian M, Kamali A, Tabatabaeichehr M, Arashnia P (2016). "Septic Cavernous Sinus Thrombosis: A Case Report". Iran Red Crescent Med J. 18 (8): e34961. doi:10.5812/ircmj.34961. PMC 5068248. PMID 27781123.
  3. ↑ Zahller M, Spector RH, Skoglund RR, Digby D, Nyhan WL (1980). "Cavernous sinus thrombosis". West J Med. 133 (1): 44–8. PMC 1272185. PMID 7222646.
  4. ↑ Chaudhry IA, Al-Rashed W, Arat YO (2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMC 3277022. PMID 22346113.
  5. ↑ Lowe RF (1962). "ACUTE ANGLE-CLOSURE GLAUCOMA: THE SECOND EYE: AN ANALYSIS OF 200 CASES". Br J Ophthalmol. 46 (11): 641–50. PMC 510261. PMID 18170827.
  6. ↑ See JL, Aquino MC, Aduan J, Chew PT (2011). "Management of angle closure glaucoma". Indian J Ophthalmol. 59 Suppl: S82–7. doi:10.4103/0301-4738.73690. PMC 3038501. PMID 21150039.
  7. ↑ Herholz K, Langen KJ, Schiepers C, Mountz JM (2012). "Brain tumors". Semin Nucl Med. 42 (6): 356–70. doi:10.1053/j.semnuclmed.2012.06.001. PMC 3925448. PMID 23026359.
  8. ↑ Kheirollahi M, Dashti S, Khalaj Z, Nazemroaia F, Mahzouni P (2015). "Brain tumors: Special characters for research and banking". Adv Biomed Res. 4: 4. doi:10.4103/2277-9175.148261. PMC 4300589. PMID 25625110.
  9. ↑ Maschio M (2012). "Brain tumor-related epilepsy". Curr Neuropharmacol. 10 (2): 124–33. doi:10.2174/157015912800604470. PMC 3386502. PMID 23204982.
  10. ↑ Shownkeen H, Bova D, Origitano TC, Petruzzelli GJ, Leonetti JP (2001). "Carotid-cavernous fistulas: pathogenesis and routes of approach to endovascular treatment". Skull Base. 11 (3): 207–18. PMC 1656855. PMID 17167622.
  11. ↑ Ellis JA, Goldstein H, Connolly ES, Meyers PM (2012). "Carotid-cavernous fistulas". Neurosurg Focus. 32 (5): E9. doi:10.3171/2012.2.FOCUS1223. PMID 22537135.
  12. ↑ Chaudhry IA, Elkhamry SM, Al-Rashed W, Bosley TM (2009). "Carotid cavernous fistula: ophthalmological implications". Middle East Afr J Ophthalmol. 16 (2): 57–63. doi:10.4103/0974-9233.53862. PMC 2813585. PMID 20142962.
  13. ↑ Kline LB, Hoyt WF (2001). "The Tolosa-Hunt syndrome". J Neurol Neurosurg Psychiatry. 71 (5): 577–82. PMC 1737614. PMID 11606665.
  14. ↑ Paović J, Paović P, Bojković I, Nagulić M, Sredović V (2012). "Tolosa-Hunt syndrome--diagnostic problem of painful ophthalmoplegia". Vojnosanit Pregl. 69 (7): 627–30. PMID 22838177.
  15. ↑ Halabi T, Sawaya R (2018). "Successful Treatment of Tolosa-Hunt Syndrome after a Single Infusion of Infliximab". J Clin Neurol. 14 (1): 126–127. doi:10.3988/jcn.2018.14.1.126. PMC 5765250. PMID 29629550.

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