OVERVIEW
OVERVIEW
Cavernous sinus syndrome is caused by a purulent or systemic infection of the periorbital, nasal, and facial areas. Lesions involve one or both cavernous sinuses. Acute onset of symptoms with fever, headache, nausea, vomiting, impaired consciousness and other toxic symptoms of infection. Impaired orbital venous return can lead to periorbital, eyelid, conjunctival edema and eyeball protrusion. Damage to the arterio-ocular nerve, the buccal nerve, the abducens nerve and the 1st and 2nd branches of the trigeminal nerve, pupil dilatation, loss of light reflex, ptosis, diplopia, limitation or fixation of the movement of all sides of the eyeballs, hypoalgesia in the area of distribution of the 1st and 2nd branches of the trigeminal nerve, loss of corneal reflex, and so on. Infection and thrombosis of the cavernous sinus segment of the internal carotid artery, carotid artery tenderness and manifestations of internal carotid artery occlusion, such as contralateral hemiparesis and hemiplegia. Meningitis may complicate.
Whether medical insurance
yes
Department
Neurology, Neurosurgery, Endocrinology, Ophthalmology
Synonyms
Foix syndrome, Pituitary pterygoid syndrome, Cavernous sinus thrombosis syndrome
Clinical Symptoms
Acute onset, with fever, headache, nausea, vomiting, impaired consciousness and other symptoms of infection and poisoning. Impaired orbital venous return may result in periorbital, eyelid, conjunctival edema and ocular protrusion. Damage to the arterio-ocular nerve, the buccal nerve, the abducens nerve and the 1st and 2nd branches of the trigeminal nerve, pupil dilatation, loss of light reflex, ptosis, diplopia, limitation or fixation of the movement of all sides of the eyeballs, hypoalgesia in the area of distribution of the 1st and 2nd branches of the trigeminal nerve, loss of corneal reflex, and so on. Infection and thrombosis of the cavernous sinus segment of the internal carotid artery, carotid artery tenderness and manifestations of internal carotid artery occlusion, such as contralateral hemiparesis and hemiplegia.
Hazards
Due to the anatomical location of cavernous sinus, it is difficult to treat, especially cavernous sinus syndrome caused by tumor, which often leaves obvious sequelae and seriously affects the quality of life.
Complications
Meningitis
Examination
Physical examination, hematological examination, CT scan, magnetic resonance imaging, cerebral angiography, histopathological examination and so on.
Diagnosis
Diagnosis can be made on the basis of the characteristic manifestations such as ocular muscle paralysis, pain, proptosis, etc. and the findings of imaging examination.
Treatment principle
Treatment for the cause of the disease, such as antibiotic treatment of infection, improvement of metabolic disorders, surgical removal of necrotic tissue.
Curability
Aggressive treatment can significantly improve the prognosis, and most of the damage involving cavernous sinus is treatable.
Dietary recommendations
Give high protein, high calorie and high vitamin diet to improve the nutritional status of patients.
Etiology
Epidemiology
The disease can occur at all ages and is usually unilateral.
Etiology
Trauma, pituitary tumor, cavernous sinus tumor, cavernous sinus aneurysm, internal carotid artery cavernous sinus fistula and cavernous sinus thrombophlebitis are the main etiologies.
Symptoms and diagnosis
Typical symptoms
1. Cavernous sinus tumor
The main symptom is acute or chronic progressive ocular muscle paralysis, diplopia is the most common accompanying symptom, sometimes painful diplopia can occur. Pituitary adenomas may present with endocrine symptoms and loss of vision.
2. Carotid-cavernous artery aneurysm
It is common in elderly patients, presenting as subacute or chronic ophthalmoplegia. Occasionally, pain similar to triple neuralgia occurs.
3. Internal carotid artery cavernous sinus fistula
Direct fistulas present with marked acute symptoms. Indirect fistulas are characterized by mild ophthalmoplegia, chronic diplopia, ptosis, ocular congestion, and loss of vision, and patients may complain of intracranial “noise”.
4. Cavernous sinus thrombosis
Postbulbar pain, ptosis, and diplopia may be the first symptoms suggesting extension of the damage to the cavernous sinus.
5. Various inflammatory lesions
Idiopathic inflammation of the cavernous sinus is called painful ophthalmoplegia because of the severe pain that occurs in the patient.
Diagnostic basis
1. unilateral and isolated, Ⅳ or Ⅵ pairs of cerebral nerve paralysis; combined oculomotor palsy; painful oculomotor palsy; proptosis; ocular and intracranial murmurs; conjunctival congestion, conjunctival venous arterial hemorrhage; hypermetropia; optic nerve disk edema, retinal hemorrhage; sensory deficits of ophthalmic branches of the trigeminal nerve with (or without) corneal reflexes; pupil fixation, reflexes are lost.
2. Imaging examination of orbital, pterygoid, and parasaddle regions is performed, and cavernous sinus tumors, cavernous sinus aneurysms, and other lesions can be seen. Cerebral angiography can confirm the diagnosis of cavernous sinus fistula.
Treatment
Treatment guidelines
According to the primary disease causing cavernous sinus syndrome, appropriate treatment means are adopted, such as surgical resection of tumor, radiotherapy and chemotherapy.
Drug treatment
1. Antibiotic treatment can be considered for cavernous sinus syndrome caused by infectious inflammation, and anticoagulant drugs can be added for those with thrombosis.
2. Non-infectious inflammation can be given glucocorticoid treatment.
3. Oral dopamine agonist can improve the symptoms in patients with pituitary tumor and prolactinoma.
Radiotherapy
Metastatic cavernous sinus tumor can be treated with radiotherapy, such as nasopharyngeal carcinoma which is very sensitive to radiation.
Surgical treatment
1. Surgical resection of cavernous sinus tumor can be chosen for surgical resection of the tumor.
2. Cavernous sinus aneurysm is treated by endovascular balloon embolization.
3. Internal carotid artery cavernous sinus fistula can be treated by endovascular spring coil embolization of the fistula.
Prognosis
The prognosis of this disease is related to the cause of the disease, such as cavernous sinus fistula, infectious inflammation caused by cavernous sinus syndrome has a better long-term prognosis; cavernous sinus syndrome caused by the tumor has a lower survival rate of 5 years after surgery, and often left with postoperative cerebral nerve paralysis symptoms.
Nursing care
Daily care
1. Surgical patients should avoid actions that increase the pressure in the abdominal and thoracic cavities, such as coughing and breath-holding.
2. Exercise appropriately and maintain a regular routine.
3. Pay attention to oral and skin hygiene and avoid crowded places to avoid infection.
4. Take medication as prescribed by the doctor and have regular checkups.
Diet
1. Enhance nutrition, consume more high protein, high vitamin, fiber-rich, non-stimulating diet.
2. Avoid smoking and alcohol.
3. If the oral reaction of radiotherapy patients is serious, give them a semi-liquid diet.