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QuestionChoice
This patient has a cavernous sinus syndrome, probably due to a thrombus secondary to cavernous sinus infection. She is at higher risk of infection due to her poorly controlled diabetes and her recent paranasal sinus surgery. The cavernous sinus houses cranial nerves III, IV, VI, Va and Vb, and the internal carotid artery. The changes are ipsilateral to the side of the lesion. There is also an issue with venous drainage from the facial vein leading to chemosis, periorbital oedema, orbital pain and proptosis. Associated complications include seizures, septic emboli, Horner syndrome and intracranial hypertension.
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Abducens nerve palsy
QuestionChoice
Sensation to the skin overlying the chin is provided by Vc (the mandibular branch of the trigeminal nerve). This does not run through the cavernous sinus.
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Loss of sensation over the chin
QuestionChoice
Sensorineural deafness occurs due to disorders of the vestibulocochlear (VIII) nerve. This nerve does not run through the cavernous sinus.
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Sensorineural deafness on the left
QuestionChoice
Relative afferent pupillary defects are present when there are issues with the afferent pathway of the pupillary reflex, that is, retinal or optic nerve pathology. Neither are involved in cavernous sinus syndrome.
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Relative afferent pupillary defect
QuestionChoice
The facial nerve does not run through the cavernous sinus; therefore, this option is incorrect.
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b
Facial nerve palsy
QuestionComment
A very good question- tests anatomy and clinical knowledge x
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allow being a sweat. 

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Fever Hallux
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Retrograde Vitamin
QuestionComment
Not me thinking that this patient has hyperthyroidism...
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Monoclonal Lumbar
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# Summary

Central Venous Sinus Thrombosis (CVST) is a rare but serious condition involving the occlusion of cerebral venous sinuses. It primarily affects younger individuals, with women at higher risk, particularly those of childbearing age. Risk factors include hormonal influences, prothrombotic conditions, systemic diseases, and local factors like trauma or infection. Symptoms are variable but often include headaches, neurological deficits, and seizures. Diagnosis is typically confirmed with imaging, such as CT venogram. Management involves anticoagulation therapy, usually starting with low molecular weight heparin and possibly transitioning to Warfarin, along with addressing underlying causes.

# Definition

Central Venous Sinus Thrombosis (CVST) refers to occlusion of venous vessels in sinuses of the cerebral veins

# Epidemiology

CVST has an incidence of approximately 3-4 cases per million people per year. Representing 0.5%-3% of all the types of stroke, affecting predominantly younger people. Women are affected more than men and mostly between the ages of 20 and 35. This is hypothesised to be due to pregnancy and the use of the COCP.

# Risk factors

Risk factors are similar to those for venous thromboembolism and include: 

- Hormonal factors (the pill, pregnancy, and the peri-partum period)
- Prothrombotic haematological conditions or malignancy
- Systemic disease (such as dehydration or sepsis)
- Local factors (skull abnormalities, trauma, or local infection
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# Presentation

- Presentation is variable but common symptoms include headache, confusion/drowsiness, impaired vision, and nausea/vomiting.

- Other signs include seizures, reduced consciousness, focal neurological deficits, cranial nerve palsies, and papilloedema.

# Investigations

- Non-contrast CT reveals a hyperdensity in the affected sinus.

- CT venogram is used to look for a filling defect ('the empty delta sign').

The most common form of dural venous thrombosis affects the superior sagittal sinus.

Cavernous sinus thrombosis is less common. It is typically caused by spreading sinus infection and presents with chemosis, exophthalmos, and peri-orbital swelling.

# Management

The mainstay of treatment is with low molecular weight heparin (LMWH) and addressing any underlying risk factors that may increase risk of clotting e.g. cancer, autoimmune disease.

Following initial therapy with LMWH, this can be further bridged to a vitamin K antagonist such as Warfarin. 

# References

[Click here for more info on intracranial venous thrombosis](https://patient.info/doctor/intracranial-venous-thrombosis)
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Central Venous Sinus Thrombosis
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Neurology
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Central Venous Sinus Thrombosis
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Intracranial Venous Thrombosis
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Central Venous Sinus Thrombosis
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Quesmed Tutorial: Advanced Neurology
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Cavernous sinus syndrome can present with cranial nerve palsies, particularly affecting the abducens nerve, leading to diplopia and ocular motility issues.
A 42-year-old woman presents with a 2-d history of reduced sensation to the left side of her face. She also has double vision and is struggling with pain in her left eye. She has a past medical history of poorly controlled type 2 diabetes and underwent paranasal sinus surgery 4 d ago. On examination, there is extensive left-sided periorbital oedema and proptosis. Her temperature is 38.4 °C.

What additional finding might be present on physical examination?
a