Cavernous Sinus Syndrome


This is a clinical diagnosis. Dysfunction of cranial nerves III, IV, and VI, and the superior divisions of cranial nerve V.

Investigations to consider:

Blood tests:

  • FBC, U&E, fasting Glucose
  • Vasculitic screen, ESR, CRP, ANCA, ANA, ENA
  • Tests for infections: Borrelia serology, HIV

MRI pre and post contrast:

  • Pituitary tumors, meningioma, metastasis
  • Aneurysms: flow voids, hypointense

If vascular lesion is suspected, CTA:

  • Carotid siphon aneurysm
  • Carotid cavernous fistula CCF: opacification of cavernous sinuses
  • Cavernous sinus thrombosis: filling defects during venous phase

2nd line, Catheter angiography: direct vs. indirect (meningeal feeding) carotid cavernous fistula CCF
LP, CSF analysis

Causes of cavernous sinus syndrome:

  • Cavernous sinus infection
  • Tumor
  • Internal carotid artery aneurysms
  • Wegener’s granulomatosis
  • Tolosa hunt syndrome

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