Materiały źródłowe

• #1 Cavernous Sinus Thrombosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448177/

  Cavernous sinus thrombosis is usually septic, but can also be aseptic. Septic cases can follow central facial infections, especially within the danger triangle of the face (from the corners of the mouth to the bridge of the nose). These include abscess or cellulitis, sinusitis (especially sphenoiditis and ethmoiditis), dental infections, extractions or procedures (even a posterior superior alveolar nerve block entering the pterygoid plexus), maxillofacial surgery, otitis media, and mastoiditis. Aseptic causes are less common than septic causes. These include trauma, surgery, or pregnancy. […] A variety of infectious organisms can cause cavernous sinus thrombosis although the majority are bacterial. Staphylococcus aureus may account for two-thirds of cases, and methicillin resistance should be considered. Other typical organisms include Streptococcus species (approximately 20% of cases), pneumococcus (5%), gram-negative species such as Proteus, Hemophilus, Pseudomonas, Fusobacterium, Bacteroides, as well as gram-positive species such as Corynebacterium and Actinomyces. Several of these (Bacteroides, Actinomyces, Fusobacterium) are anaerobic. Fungal infection in cavernous sinus thrombosis is less common but can include Aspergillosis (most common), Zygomycosis (such as Mucormycosis) or Coccidiomycosis in immunocompromised individuals. Rare precipitants of cavernous sinus thrombosis can include parasites, such as toxoplasmosis, malaria, and trichinosis, as well as viral causes such as herpes simplex, cytomegalovirus, measles, hepatitis, and human immunodeficiency virus (HIV).

• #2 Cavernous sinus thrombosis – Wikipedia

  https://en.wikipedia.org/wiki/Cavernous_sinus_thrombosis

  Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. This is a rare disorder and can be of two types: septic cavernous thrombosis and aseptic cavernous thrombosis. The most common form is septic cavernous sinus thrombosis. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth. […] Septic CST most commonly results from contiguous spread of infection from a nasal furuncle (50%), sphenoidal or ethmoidal sinuses (30%) and dental infections (10%). Less common primary sites of infection include tonsils, soft palate, middle ear, or orbit (orbital cellulitis). […] Staphylococcus aureus is the most common infectious microbe, found in 70% of the cases. Streptococcus is the second leading cause. Gram-negative rods and anaerobes may also lead to cavernous sinus thrombosis. Rarely, Aspergillus fumigatus and mucormycosis cause CST. […] Aseptic cavernous sinus thrombosis is much less common and is usually associated with other disorders including trauma, circulatory problems, nasopharynx cancers and other tumors of the skull base, dehydration, and anemia.

• #3 Cavernous Sinus Thrombosis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23520-cavernous-sinus-thrombosis

  Cavernous sinus thrombosis is a rare blood clot that can form in response to an infection in your face or head. […] Cavernous sinus thrombosis is most often a complication of a bacterial infection in your face or skull. The blood in your cavernous sinus veins clots to prevent the infection from spreading. […] In up to 70% of cases, Staphylococcus aureus bacteria cause the infection. Other types of bacteria and some fungi may also cause infections that lead to cavernous thrombosis. […] Rarely, the clot forms in response to a head injury instead of an infection.

• #4 Cavernous Sinus Thrombosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/791704-overview

  Cavernous sinus thrombosis (CST) is usually a late complication of an infection of the central face or paranasal sinuses. Other causes include bacteremia, trauma, and infections of the ear or maxillary teeth. CST is generally a fulminant process with high rates of morbidity and mortality. […] Cavernous sinus thrombosis is usually a late complication of an infection of the central face or paranasal sinuses. Other causes include bacteremia, trauma, and infections of the ear or maxillary teeth. Cavernous sinus thrombosis is generally a fulminant process with high rates of morbidity and mortality. […] Staphylococcus aureus accounts for approximately 70% of all infections. Streptococcus pneumoniae, gram-negative bacilli, and anaerobes can also be seen. Fungi are a less common pathogen and may include Aspergillus and Rhizopus species.

• #5 Cavernous Sinus Thrombosis – Eye Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/cavernous-sinus-thrombosis

  Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. […] Cavernous sinus thrombosis is an extremely rare complication of common facial infections, most notably nasal furuncles, sphenoidal or ethmoidal sinusitis (greater than 50%), and dental infections. […] Most common pathogens are Staphylococcus aureus (70%), followed by Streptococcus species; anaerobes are more common when the underlying condition is dental or sinus infection. […] Thrombosis of the lateral sinus (related to mastoiditis) and thrombosis of the superior sagittal sinus (related to bacterial meningitis) occur but are rarer than cavernous sinus thrombosis. […] Cavernous sinus thrombosis is an extremely rare complication of infections such as nasal furuncles, sphenoidal or ethmoidal sinusitis, and dental infections.

• #6 Cavernous sinus thrombosis | PPT

  https://www.slideshare.net/slideshow/cavernous-sinus-thrombosis-44738087/44738087

  Septic cavernous sinus thrombosis is usually caused by infection spreading from nearby sites like the nose, orbit, or teeth. […] Septic type (most common) – coagulase positive staphylococcus. Aseptic types may follow trauma, local stasis or a failing circulation. […] More commonly seen with sphenoid and ethmoid and to a lesser degree with frontal sinusitis. Staphylococcus aureus -70% of all infections. Streptococcus pneumoniae, gram-negative bacilli, and anaerobes can also be seen. Fungi are a less common pathogen and may include Aspergillus and Rhizopus species(more common in diabetics). […] Infection of upper lip, vestibule of nose and eyelids- spread by way of angular, supraorbital, supratrochlear veins to ophthalmic veins=commonest route. […] Sources: Nose Paranasal 40% Orbit- Face 35% Mouth Teeth 13% Ear 9% Other tonsil, soft palate, pharynx, posterior portions of the superior and inferior alveolar arches 3%.

• #7

  https://www.nhs.uk/conditions/cavernous-sinus-thrombosis/causes/

  Cavernous sinus thrombosis is usually caused by a bacterial infection that spreads from another area of the face or skull. […] Many cases are the result of an infection of staphylococcal (staph) bacteria, which can cause: […] In most cases of cavernous sinus thrombosis, a blood clot forms in the cavernous sinuses to try to prevent bacteria spreading further into the body. […] Less commonly, a blood clot can develop in the cavernous sinuses, due to: […] a severe head injury […] an infection spreading from the teeth or gums (dental abscess) […] a fungal infection […] a health condition or other underlying factor that makes you more prone to blood clots, the most common being pregnancy […] conditions that cause inflammation to develop inside the body, such as lupus or Behet’s disease […] some types of medicine, such as the contraceptive pill, although this is very rare […] a complication of coronavirus (COVID-19) infection […] a very rare side effect after having some types of COVID-19 vaccine.

• #8 Cavernous Sinus Syndrome – EyeWiki

  https://eyewiki.org/Cavernous_Sinus_Syndrome

  A CSS is caused by any pathology or lesion present within the cavernous sinus that disrupts the function of other anatomical structures. The most common cause of CSS is mass effect from tumor. Other common causes of CSS include trauma and self-limited inflammatory disease. Less common causes are vascular etiologies and infections. […] One important infectious etiology of CSS includes cavernous sinus thrombosis (CST), which may present initially to an ophthalmologist and requires urgent management due to its life-threatening prognosis. Septic CST is typically seen as a complication of a facial infection, such as sinusitis or cellulitis. Due to the valveless nature of the facial veins, the sinuses are vulnerable to stagnation and poor drainage in the setting of severe infection, causing the formation of a thrombus. The thrombus can then cause damage locally or travel to the brain, causing stroke-like symptoms or encephalitis and meningitis.

• #9 Cavernous Sinus Thrombosis: Efficiently Recognizing and Treating a Life-Threatening Condition

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8451531/

  Cavernous sinus thrombosis (CST) can develop as a result of both infectious and noninfectious conditions. Infections in the middle part of the face caused by Staphylococcus aureus are the most common cause of septic thrombosis of the cavernous sinuses. Paranasal (typically sphenoid) sinusitis, dental abscess, and, less commonly, otitis media are other antecedent sources of infection. […] Cavernous sinus thrombosis (CST) is a rare, life-threatening condition that can occur as a result of a face infection, sinusitis, orbital cellulitis, pharyngitis, or otitis media. It can also result from a serious injury or surgery, especially in the presence of a thrombophilic disorder. […] The most prevalent causes of CST are sphenoid and ethmoid sinusitis, as well as frontal sinusitis. Over 70% of all infections are caused by the bacteria Staphylococcus aureus. There are also Streptococcus pneumoniae, Gram-negative bacilli, and anaerobes present. Fungi, which include Aspergillus and Rhizopus species, are a less common pathogen.

• #10

  https://link.springer.com/article/10.1007/s00405-018-5062-9

  Septic cavernous sinus thrombosis (CST) is a rare complication of infections in the head and neck area. CST is notorious for its bad prognosis, with high mortality and morbidity rates described in literature. […] In most patients, CST was caused by sinusitis of the sphenoid sinus (n=6). Other causes were otitis media (n=2), acute invasive fungal rhinosinusitis (n=1), infections in the pharynx (one parapharyngeal and one retropharyngeal abscess), and varicella meningitis (n=1). […] In our series, sinusitis is the most common cause of CST (50% of the cases). This is in corroboration with other reports. CST can also be caused by other infections in the head and neck area. Infections of the middle ear and mastoid, mid-facial infections, oral and dental infections, tonsillitis and pharyngitis have been described as sources of CST.

• #11

  https://journals.lww.com/md-journal/fulltext/2023/11240/septic_cavernous_sinus_thrombosis_presenting_as.115.aspx

  Septic cavernous sinus thrombosis (SCST) is a rare infectious thrombophlebitic disease. The infection often arises from the tissues surrounding the cavernous sinus as well as the cavernous sinus drainage. […] The most common etiology of SCST is paranasal sinus infection. In addition to infection caused by venous drainage, direct infiltration of the infection into the CS is also a main cause. […] We believe that the patient in this case may cause SCST after drainage of the CS through inflammation of the paranasal sinus, and the internal carotid artery in the CS may be infiltrated by inflammation, leading to the destruction of the internal carotid artery intima. […] Acute cerebral infarction caused by SCST is extremely rare, and its pathogenesis has not been fully elucidated. It has been suggested that local compression and stenosis of the internal carotid artery leads to increased local blood flow velocity and local vortex formation, which results in thrombosis, thereby leading to the formation of acute infarct foci by blockage of distal branches.

• #12 Cavernous Sinus Thrombosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448177/

  The biggest risk factors are facial infections, acute sinusitis, and periorbital infections. Thrombophilia is a significant risk factor for cavernous sinus thrombosis. Women who are pregnant, post-partum, or receiving oral contraceptives or hormone replacement therapy may be at increased risk. A variety of thrombophilic genetic disorders may lead to cavernous sinus thromboses. These include factor V Leiden mutation, prothrombin G20210A mutation, antithrombin III, protein C or S deficiency, or increased factor VIII. Acquired disorders such as antiphospholipid antibody syndrome, hyperhomocysteinemia, heparin-induced thrombocytopenia, and obesity could also contribute to cavernous sinus thrombosis risk. Other risk factors for thrombosis include severe dehydration, such as in the hyperosmolar non-ketotic state, nephrotic syndrome, and sickle cell disease.

• #13 Cavernous sinus thrombosis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/956

  Cavernous sinus thrombosis (CST) is a thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic condition. […] In the pre-antibiotic era, infections of the middle third of the face were responsible for the majority of cases. Currently, acute sinusitis is the most common predisposing condition. […] Aseptic CST is usually a thrombotic process that is a result of trauma, iatrogenic injuries, or prothrombotic conditions. […] Risk factors include recent history of acute sinusitis, history of facial infections, history of periorbital infection, history of otitis media, mastoiditis, or petrositis, history of dental or oral infection, history of sepsis, immunosuppression, genetic prothrombotic condition, acquired and other prothrombotic states, history of head and neck trauma, use of oral contraceptives, pregnant or postpartum, history of malignancy, history of recent head or neck surgery, vascular abnormalities, ulcerative colitis, volume depletion, and heroin overdose.

• #14 Cerebral Venous Sinus Thrombosis (CVST) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/cerebra-venous-sinus-thrombosis-cvst

  In rare cases, a blood clot can form in a venous sinus. This is a condition known as cerebral venous sinus thrombosis. […] When a blood clot forms in a cerebral venous sinus, it functions like a stopper in a bottle and effectively blocks the flow of blood. […] CVST has been associated with the following risk factors: Oral contraceptives, Pregnancy and the first month and a half after childbirth, Hormone replacement therapy, Inflammatory diseases and conditions (inflammatory bowel disease, systemic lupus erythematosus, sarcoidosis, Behet disease, granulomatosis with polyangiitis), Nephrotic syndrome, Antiphospholipid syndrome, Genetic conditions that increase the tendency to form blood clots (factor V Leiden mutation, protein C deficiency, protein S deficiency, antithrombin deficiency, prothrombin gene mutation, hyperhomocysteinemia), Certain infections of the head and neck (meningitis, sinusitis, otitis, mastoiditis), Head injury, previous neurosurgery.

• #15 Cavernous Sinus-Orbital Vein Thrombosis due to Infection and Thrombophilia | Jaffry | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/33/42

  The aseptic cases of CST can be seen in debilitated patients (marasmic phlebothrombosis) at the extremes of age, with the etiologic factors being anemia, hypercoagulability, dehydration, hypotension allowing stagnation of blood, carotid aneurysms, surgical treatment of trigeminal neuralgia. […] The increase in incidence of thromboembolism is also supported by studies that have shown that patients taking estrogens or combined oral contraceptives have increased platelet aggregation, accelerated blood clotting, altered blood concentrations of some clotting factors, and altered fibrinolytic activity related to decrease in antithrombin III. […] The inherited thrombophilias are the leading cause of maternal thromboembolism and are associated with an increased risk of certain adverse pregnancy outcomes including second- and third-trimester fetal loss.

• #16 Neurovascular Behçet’s Disease Presenting with Cavernous Sinus Thrombosis: A Rare Case of Assumed Tolosa-Hunt-Like Syndrome | Volume 35 – Issue 1 – March 2020 | Archives of Rheumatology

  https://tjr.org.tr/full-text/1064

  Behets disease (BD) is a rare, chronic, auto-inflammatory disorder of unknown origin. […] The prevalence of cerebral venous sinus thrombosis (CVST) in BD is 8%, which corresponds to 18% of neurovascular BD (neuro-BD). […] However, cavernous sinus thrombosis occurs in only 2.9% of patients with CVST. […] The pathophysiology of BD is characterized by inflammation of small arteries and veins, and thrombosis as a result of vasculitis of the vasa vasorum. […] Endothelial dysfunction caused by vascular inflammation is primarily responsible for the increased frequency of thrombosis. […] The etiology of THS has been attributed to nonspecific granulomatous inflammation of uncertain etiology involving the septa and the wall of the cavernous sinus characterized by lymphocyte and plasma cell infiltration, formation of giant cell granulomas, and fibroblast proliferation. […] In conclusion, we experienced the first case of cavernous sinus thrombosis as a complication of BD with very rare neurological symptoms mimicking THS such as ophthalmoplegia, ipsilateral headache and diplopia treated with corticosteroids.

• #17 A Case Report of Cavernous Sinus Thrombosis in a 40-year-old pati

  https://www.iomcworld.org/open-access/a-case-report-of-cavernous-sinus-thrombosis-in-a-40yearold-patient-with-adenocarcinoma-of-unknown-primary-origin-93505.html

  We herein report a case of bilateral Cavernous Sinus Thrombosis in a 40-yearold male in the setting of nasopharyngeal adenocarcinoma of unknown primary origin. […] Out of all cases of cerebral and dural venous sinus thrombosis, malignancy as a cause accounts for 7.4% which shows that the risk of CST in malignancy is increased by 5-fold. […] Malignancy is an extremely rare cause of CST and here we present a unique case of left-sided CST that eventually progressed to the right side in a 40-year-old male with extensive metastasis of adenocarcinoma of unknown primary origin. […] Cavernous Sinus Thrombosis in and itself is a very rare condition and malignancy as a cause of CST is indeed very rare. […] Aseptic causes of CST include trauma, surgery, pregnancy, oral contraceptive pill usage, and malignancy. […] Coagulopathy in cancer is speculated to be an adverse effect of radiation causing vessel injury or chemotherapy itself, compression, or infiltrating the vasculature. […] CST in the setting of malignancy is very rare and there are very few cases reported in the literature.

• #18 Cavernous Sinus Thrombosis: Symptoms, Causes and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/cavernous-sinus-thrombosis-symptoms-causes-and-treatment

  Cavernous sinus thrombosis is typically caused due to bacterial infection that spreads from the face and skull. Up to 70% of cases are a result of a staphylococcal bacterial infection. Typically, cavernous sinus thrombosis is the result of an infection that has spread beyond the sinuses, teeth or face. […] Although rarely, infections of the eyes or ears may also lead to cavernous sinus thrombosis. […] To stop the infection, the immune system of our body creates a clot in order to prevent bacteria or other pathogens from spreading. This clot increases the pressure inside the brain and this pressure, in turn, can damage the brain and may cause death ultimately. […] In rare cases, cavernous sinus thrombosis may also result from a severe blow to the head. […] Cavernous sinus thrombosis is found to be more common in people who take certain medicines like oral contraceptives or those who have underlying health conditions like uncontrolled diabetes or cancer that may increase their risk for blood clots.

• #19 Cerebral Venous Sinus Thrombosis (CVST) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/cerebra-venous-sinus-thrombosis-cvst

  In the vast majority of cases, people who experience CVST have one or more of these risk factors. In some cases, however, doctors are unable to identify any known risk factors or causes. […] The blood clotting condition experienced by these women who received the Johnson Johnson vaccine is known as thrombosis with thrombocytopenia syndrome (TTS) or vaccine-induced immune thrombotic thrombocytopenia (VITT). […] TTS can cause blood clotting in common sites, such as deep vein thromboses or pulmonary embolisms, but it can also lead to clotting in atypical sites, including the cerebral venous sinuses.

• #20 Cavernous sinus thrombosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cavernous-sinus-thrombosis?lang=us

  Cavernous sinus thrombosis (CST), the presence of thrombus in the cavernous sinus, is a rare condition, most commonly infectious in nature, and the diagnosis on imaging is not always straightforward. It has high mortality and morbidity rates. […] Etiology: contiguous spread of infection, typically Staphylococcus aureus (~55%): paranasal sinuses, middle third of the face, dental abscess or orbital cellulitis (less common). […] Cavernous sinus thrombosis from a septic etiology occurs due to embolization of bacteria which trigger thrombosis that becomes trapped within the cavernous sinus. […] Thrombus can propagate into the dural system as the lack of valves in the dural sinus allow flow through emissary veins into and out of the cavernous sinus. […] Thrombophilic conditions, e.g. protein C/S deficiency, oral contraceptive use, malignancy, pregnancy. […] idiopathic (25%).

• #21 Cavernous Sinus Thrombosis as a Complication of Cerebro-Rhino Orbital Mucormycosis Associated With Covid-19: A Case Report

  https://clinmedjournals.org/articles/ijodh/international-journal-of-oral-and-dental-health-ijodh-8-147.php?jid=ijodh

  Venous drainage and arterial blood supply to the orbits and sinuses lends itself to spread of bacterial and fungal pathogens to the cavernous sinus in a retrograde manner through the superior and inferior ophthalmic veins. […] Mucormycosis is a fungal infection contracted by inhalation of Mucor and Rhizopus spores in the atmosphere, mainly affecting immunocompromised patients. The angioinvasive nature of Mucor leads to vasculitis and thrombosis that progress to tissue infarction and necrosis. […] Cavernous sinus thrombosis may be difficult to detect by CT or MR imaging in the early phase of the disease, Therefore, astute clinical examination with a high index of suspicion for cavernous sinus thrombosis, supported by known risk factors of diabetes, malignancy and immunosuppression, can lead to a diagnosis.

• #22 CEREBRAL VENOUS SINUS THROMBOSIS (Chapter 66) – Uncommon Causes of Stroke

  https://www.cambridge.org/core/books/uncommon-causes-of-stroke/cerebral-venous-sinus-thrombosis/A938D533982F84DC2DF1C3710F924263

  Cerebral venous sinus thrombosis (CVST), although a relatively rare cause of stroke, is important to diagnose and treat early because of the significant morbidity and mortality associated with it. […] CVST can also follow traumatic injury to the venous sinuses or jugular veins after neurosurgical or other procedures. […] The major pathology in CVST is thrombosis of cerebral veins or dural sinuses leading to impaired drainage, venous hypertension with subsequent edema formation, venous infarction, and hemorrhage.

• #23 Cavernous Sinus Thrombosis – MD Searchlight

  https://mdsearchlight.com/blood-disorders/cavernous-sinus-thrombosis/

  Cavernous sinus thrombosis is a rare condition, making it hard to estimate how many new cases occur each year. Judging by the data we do have, it makes up about 1% to 4% of a similar condition called cerebral venous and sinus thrombosis, which affects two to four out of every million people each year. […] Cavernous sinus thrombosis can occur from an infection (septic) or from non-infectious causes (aseptic). Septic occurrences often follow infection around the center of the face, especially the area from the corners of the mouth to the bridge of the nose. These infections could be abscesses, cellulitis, sinusitis, dental infections, or complications following certain procedures or surgeries. Less common are aseptic causes, which include trauma, surgery, or pregnancy.

• #24 Cavernous Sinus Thrombosis: Efficiently Recognizing and Treating a Life-Threatening Condition

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8451531/

  CST had a near 100% fatality rate before the introduction of powerful antibiotic treatments. The most prevalent causes of death are sepsis or a CNS infection. Because of rigorous management, the mortality rate has plummeted below 30%. However, morbidity is still significant, and full recovery is rare. These high rates of death and morbidity could be due to delayed diagnosis and antibiotic treatment.

• #25

  https://link.springer.com/article/10.1007/s00405-018-5062-9

  The prognosis of CST nowadays is more favorable than previously described. Anticoagulation seems to be a safe addition to antibiotic and surgical treatment, at least in patients without central nervous system infection. […] The explanation of the decline in mortality of CST in the last decades is sought in improved treatment and identification of less serious case by better quality and availability of imaging techniques. Our study thus adds another contemporary series that shows that mortality is not so dramatically anymore, like several recent articles suggested. […] Our series and other recent series in literature demonstrate that the prognosis of CST is not as devastating as it previously had been described. Apart from (sphenoidal) sinusitis, other infections in the head and neck area can also cause CST.

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