Cavernous Sinus Thrombosis
Cavernous sinus thrombosis can cause neuropathies of cranial nerves 3,4, 5, and 6; most commonly CN 6, because of its proximity to the carotid artery.
Causes:
- Cavernous sinus tumors:
- Meningiomas (as we can predict from the presence of the lateral dural wall – remember meningiomas grow from the dura (such as at the dural convexity)
- Pituitary adenomas, which we can guess from the proximity to the pituitary gland.
- Trigeminal schwannomas – the trigeminal ganglion lies within Meckel's cave, adjacent to the cavernous sinus.
- Carotid-cavernous fistula, in which either from trauma or spontaneously the carotid artery forms fistulas with the cavernous venous channels. See Cavernous Sinus Aneurysm.
- Infectious invasion of the cavernous sinus, most commonly from staph aureus because of the venous drainage from the face, but notably from such causes as apergillus and mucormycosis.
Painful ophthalmoplegia is the most common presenting symptom of cavernous sinus disease.
- Cavernous sinus diseases (such as thrombosis, which we addressed, and non-thrombotic causes, such as Tolosa-Hunt syndrome) often manifest with ocular pain, redness, and proptosis (bulging).
- Tolosa-Hunt syndrome is the clinical eponym of granulomatous inflammation of the cavernous sinus. As an over-simplification, we can think of it as sarcoidosis restricted to the cavernous sinus.