Paralysis of 3rd, 4th & 6th nerves with involvement of ophthalmic division of 5th nerve, localizes the lesion to
CAVERNOUS SINUS THROMBOSIS Aetiology Infection of paranasal sinuses, paicularly those of ethmoid and sphenoid and less commonly the frontal, and orbital complications from these sinus infections can cause thrombophlebitis of the cavernous sinus(es).The valveless nature of the veins connecting the cavernous sinus causes easy spread of infection. Clinical features Onset of cavernous sinus thrombophlebitis is abrupt with chills and rigors. Patient is acutely ill. Eyelids get swollen with chemosis and proptosis of eyeball. Cranial nerves III, IV and VI which are related to the sinus get involved individually and sequentially causing total ophthalmoplegia. Pupil becomes dilated and fixed, optic disc shows congestion and oedema with diminution of vision. Sensation in the distribution of V1 (ophthalmic division of CN V) is diminished. CSF is usually normal. Condition needs to be differentiated from orbital cellulitis. CT scan is useful for this. Treatment. It consists of i.v. antibiotics and attention to the focus of infection, drainage of infected ethmoid or sphenoid sinus. Blood culture should be taken before staing antibiotic therapy. Role of anticoagulants is not clear. Ref : ENT textbook by Dhingra 6th edition Pgno : 201
Cavernous Sinus
Apex of orbit
Brainstem
Base of skull
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