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Cavernous Sinus Thrombophlebitis
Infection Cavernous sinus thrombophlebitis Brief outline/clinical setting Septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Initial symptoms of cavernous sinus thrombosis are progressively severe headache or facial pain, usually unilateral and localized to retro-orbital and frontal regions. High fever is common. Later, ophthalmoplegia (typically t
| Infection | Cavernous sinus thrombophlebitis |
| Brief outline/clinical setting | Septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Initial symptoms of cavernous sinus thrombosis are progressively severe headache or facial pain, usually unilateral and localized to retro-orbital and frontal regions. High fever is common. Later, ophthalmoplegia (typically the 6th cranial nerve in the initial stage), proptosis, and eyelid edema develop and often become bilateral. Facial sensation may be diminished or absent. Decreased level of consciousness, confusion, seizures, and focal neurologic deficits are signs of central nervous system (CNS) spread. Patients with cavernous sinus thrombosis may also have anisocoria or mydriasis (3rd cranial nerve dysfunction), papilledema , and vision loss |
| Aetiologies/organisms | Staphylococcus aureus Streptococcus species Anaerobic organisms |
| Optimal antimicrobial selection | Cloxacillin 1-2g IV 4-6 hrly If poor clinical response after 48 hrs of therapy despite source control, consider change to Ceftriaxone 1g IV 12 hrly Metronidazole 500mg IV 8hrly should be added if an underlying sinusitis or dental infection is present Dexamethasone 8mg IV 8hrly if cranial nerve dysfunction is present |
| Duration | 14 days If incomplete resolution at this point, discuss with ID/Micro |
| Alternative if allergic/not available | |
| Rationale | MSD manual professional version - cavernous sinus thrombosis |
| Level of evidence | |
| Link to Guideline | Click here |