Cavernous Sinus Thrombosis: Symptoms, Causes and Treatment

Overview 

When blood clots in the cavernous sinuses, it is known as cavernous sinus thrombosis. The cavernous sinus is a hollow space behind each eye socket and underneath the brain. It is a life-threatening condition that needs immediate medical attention and can affect adults and children equally. In nearly 30% of cases of Cavernous sinus thrombosis, it causes death.

Severe headaches and swelling or bulging of one or both eyes are some of the early signs of cavernous sinus thrombosis. 

The blog explains cavernous sinus thrombosis, its symptoms, causes, diagnosis, and various treatment. 

What is Cavernous Sinus Thrombosis?

As mentioned, cavernous sinus thrombosis is a blood clot in the cavernous sinuses. The cavernous sinus is a hollow space present below the brain and behind each eye socket. The jugular vein carries blood through cavernous sinuses and away from the brain. In cavernous sinus thrombosis, the blood clot blocks the jugular vein that runs through a  hollow space underneath your brain and behind the eye sockets. These veins carry blood from the face and head back to the heart.

Usually, the clot is caused due to an infection of the face or skull. When there is an infection, the jugular vein forms a blot clot that prevents the infection from spreading further. However, it also restricts blood flow to the brain, which can cause damage to the brain, eyes, and several nerves running between them. In some cases, cavernous sinus thrombosis is caused without an infection, and other factors also play a vital role in developing this disorder.

Both adults and children are affected by cavernous sinus thrombosis. In nearly one in 3 cases of this disorder, it causes death. It is a severe condition that needs immediate medical attention.

What are the symptoms of Cavernous Sinus Thrombosis?

Cavernous sinus thrombosis symptoms may include:

• Swelling, irritation or redness around one or both the eyes
• Severe headache accompanied often by tearing
• Inability to move the eye
• Drooping eyelids
• Fatigue
• High fever
• Seizures
• Altered mental status, which may range from confusion to coma 
• Numbness or pain around the face or eyes
• Double vision or vision loss 

As cavernous sinus thrombosis affects the eyes, the patient may experience the following symptoms:

• Swelling and bulging of the eyes starts from one eye and moves to the other eye as well
• Severe pain in the eye
• Red eyes
• Vision issues, such as double or blurred vision
• Difficulty moving eyes
• Droopy eyelids
• Pain and numbness in the face and eyes

The other symptoms of cavernous sinus thrombosis are as follows:

• Sudden onset of high fever
• Vomiting
• Seizures
• Change in the mental state, such as confusion
• Severe headache accompanied by tearing
• Pain 
• Fatigue

If left untreated, the infection can spread throughout the body. Patients may experience drowsiness and slip into a coma. Death may also follow. 

When to seek medical help for Cavernous Sinus Thrombosis?

A person should immediately seek medical attention or call the healthcare provider if they experience any of the following:

• A severe headache with no relief from painkillers or a worsening headache
• Headaches that worsen when the person lies down or bends over
• Headaches that cause blurred vision, feeling of being sick, speech issues, weakness, or drowsiness
• Pain in the eye or swelling
• A  rash or bleeding under the skin
• Shortness of breath, chest pain, swelling in the leg, and constant abdominal pain

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What are causes Cavernous Sinus Thrombosis?

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.

How is Cavernous Sinus Thrombosis diagnosed?

After a physical examination and analysis of the medical history, doctors may prescribe the following tests to diagnose the condition accurately:

• Imaging Tests: MRI and CT scans allow the physician to identify blood clots in the cavernous sinuses. However, an MRI with a venogram gives a better image for accurate diagnosis. In this procedure, the doctor intravenously injects a contrast dye to see the blood flow during the MRI .
• Blood Culture Test: The patient’s blood and other bodily fluids, including sinus fluid, is tested for pathogens causing infection.
• Lumbar Puncture: In this, the doctor inserts a needle into the patient’s spine to collect a sample of the spinal fluid. The fluid is tested for bacteria and infections. It shows if the disease has spread to the brain, causing meningitis – a complication from cavernous sinus thrombosis. 

As cavernous sinus thrombosis is a life-threatening condition that quickly progresses, the doctor may immediately begin treatment before getting an accurate diagnosis.

What are the several treatment options for Cavernous Sinus Thrombosis?

As cavernous sinus thrombosis requires immediate treatment, the patient may be hospitalised in an intensive care unit. The team of doctors will closely monitor the patient. The following are the various treatment option provided to a cavernous sinus thrombosis patient:

• Antibiotics: the doctor begins with antibiotic treatment intravenously to tackle any infections causing a clot. As the treatment is time-sensitive, the patient is provided with a broad-spectrum antibiotic to destroy various infection-causing bacteria before the confirmation from multiple tests. The treatment takes place for several weeks. 
• Anticoagulants: The patient may need blood thinners, such as heparin, to break the clot and prevent new clots from forming. They may have to continue taking the medication several months after the initial treatment. These blood thinners can cause additional bleeding in the skull or cause blood clots in other body parts. The doctor recommends blood thinners only after weighing the risk and severity of the condition. 
• Corticosteroids: the doctor may prescribe steroids that reduce inflammation that puts pressure on the sinuses. These are usually administered after the completion of antibiotic treatment. 
• Sinus surgery: The doctor may also perform sinus surgery to drain out excess fluid due to infection and blood clots.

What are the risk factors of Cavernous Sinus Thrombosis?

The risk factors for adults and children are different. The following are the risk factors for children and infants:

• Issues with the way blood clots
• Sickle cell anaemia
• Chronic hemolytic anaemia
• Beta-thalassemia major
• Heart diseases
• Iron deficiency
• Dehydration 
• Head trauma
• Certain infections
• Newborns whose mother has a particular infection or history of infertility

The following are the risk factors for adults:

• Pregnancy and the first week of delivery
• Issues in blood clotting due to health conditions, including antiphospholipid syndrome, protein C and S deficiency, antithrombin 3 deficiency, lupus anticoagulant, or factor 5 Leiden mutation
• Cancer
• Collagen vascular diseases, such as lupus, Wegener’s granulomatosis, and Behcet syndrome
• Obesity
• Intracranial hypotension or low blood pressure in the brain
• Inflammatory bowel diseases like ulcerative colitis or Crohn’s disease 

What are the complications of Cavernous Sinus Thrombosis?

Cavernous sinus thrombosis may lead to severe complications. Nearly one in 3 cases is fatal. Therefore, it is essential to talk to the doctor if the patient suspects cavernous sinus thrombosis. This holds true if the patient has a recent infection.

The following are complications of cavernous sinus thrombosis:

• Impaired speech
• Problems moving body parts
• Vision issues
• Headaches 
• Increased fluid pressure inside the skull
• Pressure on nerves
• Brain injury
• Developmental delay
• Increased chances of blood clots in other body parts, such as legs and lungs
• Sepsis 
• Death

Conclusion

Cavernous sinus thrombosis is a rare and life-threatening condition that requires immediate medical attention. However, the patient can recover and continue everyday life with timely treatment. 

Frequently Asked Questions (FAQs)

Is cavernous sinus thrombosis common?

It is rare. Therefore, it is difficult to predict the numerous cases that occur annually. Due to modern medicine and the widespread availability of antibiotics, cases have declined.