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Cavernous Sinus Thrombosis

Cavernous Sinus Thrombosis is a topic covered in the 5-Minute Emergency Consult.

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  • Thrombosis of a branch of the major intracerebral venous drainage system
  • Most commonly infectious
  • Spreads from facial, odontogenic, or sinus infection
  • Less frequently occurs with hypercoagulable state

3 primary sites of thrombosis:
  • Cavernous sinus—Most common:
    • Drainage from superficial venous system
  • Superolateral to the sphenoid sinus and surrounds the sella:
    • Cranial nerves (CN) III, IV, V1, and V2 traverse the lateral wall of the sinus.
    • CN VI and the internal carotid artery occupy the medial portion of the sinus.
  • Can also involve transverse sinus and superficial sagittal sinus

  • Hematogenous spread of facial, otic, or neck infection into venous drainage system
  • Contiguous spread directly from infected sinus cavities (sphenoid, ethmoid > frontal)
  • Bacterial overgrowth leads to inflammation and coagulation, resulting in thrombosis.
  • Venous engorgement of cavernous sinus can affect adjacent structures:
    • Ophthalmoplegia from inflammation of CN III, IV, or VI
    • Pupillary fixation from CN III
    • Sensory deficits or paresthesia of forehead or cheek from CN V1 and V2


  • Septic:
    • Staphylococcus aureus accounts for 70%
    • Streptococcus pneumoniae, gram-negative bacilli, and anaerobes also seen
    • Fungi less common; include Aspergillus and Rhizopus species
  • Aseptic:
    • Less common
    • Granulomatous conditions (TB)
    • Inflammatory disorders
    • From mass effect (tumors at base of skull, aneurysms)
  • Hypercoagulable states

Pediatric Considerations
  • Children may present with nonspecific symptoms such as decreased energy, vomiting, fever.
  • Have high level of suspicion for any child with recent otitis or pharyngitis with worsening symptoms, declining mental status, or signs of increased intracranial pressure (ICP):
    • HTN, bradycardia, lethargy, vomiting, gait instability
  • More common in the neonatal period, when diagnosis can be extremely difficult to make

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Rosen, Peter, et al., editors. "Cavernous Sinus Thrombosis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307167/all/Cavernous_Sinus_Thrombosis.
Cavernous Sinus Thrombosis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307167/all/Cavernous_Sinus_Thrombosis. Accessed April 25, 2019.
Cavernous Sinus Thrombosis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307167/all/Cavernous_Sinus_Thrombosis
Cavernous Sinus Thrombosis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307167/all/Cavernous_Sinus_Thrombosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cavernous Sinus Thrombosis ID - 307167 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307167/all/Cavernous_Sinus_Thrombosis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -