Cavernous sinus thrombosis is a serious condition caused by the formation of a blood clot in the cavernous sinus or its connecting blood vessels. It commonly arises from a middle ear or dental infection that spreads through venous connections. A 60-year-old diabetic man presented with a one-week history of toothache and painful cheek after seeing a dentist. Imaging and laboratory tests aim to identify the infectious source. Complications can include vision problems, lung embolism, or stroke. Aggressive antibiotic treatment and management have reduced mortality from 100% to less than 30%.

1. CAVERNOUS SINUS TROMBOSIS

2. hollow spaces located
under bottom of brain ,
behind each eye socket

3. ◦ Medial : pituitary above, sphenoidal below
◦ Lateral : temporal lobe
◦ Anterior : SOF
◦ Posterior : petrous apex
◦ Superior : optic chiasm
Relations:

4. Contents
 oculomotor nerve (CN III)
 trochlear nerve (CN IV)
 ophthalmic nerve (CNV1)
 maxillary nerve (CNV2)
 abducens nerve (CN VI)

5. Connection :

6. Dangerous area of face

7. Def. of CST :
 Serious condition consisting in the formation
of a thrombus in cavernous sinus or its
communicating branches.

8. Etiology:

9.  Along lateral sinus and petrosal sinuses from
middle ear infections
 •Along venous plexus surrounding ICA from
middle ear
 A dental infection from osteomyelitis of
maxilla
Extension of bacteria

10. Clinical picture :

12.  male patient 60 years old, Diabetic 15 year
 presented to dentist with 1-week history
toothache and subsequent painful right
cheek
case study

13. Imaging Studies

15. Laboratory test
 CBC
 ESR
 blood cultures
 sinus culture
To identify an infectious primary source

16. Complication
 Vision problem
Lung : pulmonary embolism
 Brain : triggers a stroke

17.  Orbital cellulitis :
CST : Bil., papillodema, dilated pupil,
decreased periocular sensation
Preseptal cellulitis : no proptosis
 Orbital apex syndrome : more visual loss,
opthalmoplegia, less proptosis, periorbital
odema

18. MANAGEMENT

19. MANAGEMENT

20. Prognosis
 100% Mortality prior to effective antimicrobials.
death is due to sepsis or CNS infection.
 With aggressive management , the mortality
rate is now less than 30%

21. Questions?