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Cavernous Sinus Thrombosis, Emergency Medicine

Joanna W. Davidson Reviewed 06/2017



  • 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 hyperc...


Signs and Symptoms

  • Symptoms:

    • Headache occurs in 90% of patients.

    • Fever

    • Ocular or retrobulbar pain

    • Facial swelling

    • Visual disturbance

    • Facial dysesthesia

    • Lethargy or altered mental status

  • Signs:

    • Periorb...



  • Patients can be altered and unstable.

  • May require rapid assessment and stabilization of airway, breathing, and circulation (ABCs)

Initial Stabilization/Therapy

  • Careful assessment of...



Admission Criteria

  • All patients with sinus thrombosis warrant admission to a monitored setting.

  • Consider ICU admission.

Discharge Criteria


Followup Recommendations

Neurologic and ...

Pearls and Pitfalls

  • Diagnosis is made on clinical evaluation and confirmatory lab evidence. Maintain a high index of suspicion.

  • Noncontrast head CT is often negative or nonspecific. MRI/MRV is the diag...

Additional Reading

  • Cannon  ML, Antonio  BL, McCloskey  JJ, et al. Cavernous sinus thrombosis complicating sinusitis. Pediatr Crit Care Med.  2004;5(1):86–88.

  • Carvalho  KS, Garg  BP. Cerebral venou...



  • 325 Phlebitis and thrombophlebitis of intracranial venous sinuses

  • 437.6 Nonpyogenic thrombosis of intracranial venous sinus


  • G08 Intracranial and intraspinal phlebitis and thrombophlebitis

  • ...

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