Snapshot A 24-year-old female presents with worsening headache, fever, and double vision. Her headache is located in the periorbital region. Medical history is significant for a left-sided mid-facial furuncle which she attempted to squeeze over one week prior. On physical exam, there is bilateral supraorbital edema, lateral gaze palsy, ptosis, mydriasis, and chemosis. Introduction Thombosis of the cavernous sinus Most commonly caused by a continguously spreading infection via valveless venous vessels nose sinuses ears maxilllary teeth bacteremia e.g., sinusitis and mid-face furuncle Causitive organisms is most commonly Staphylococcus aureus (70%) others Streptococcus pneumoniae gram-negative bacilli anaerobes certain fungi Epidemiology mortality < 30% with antibiotic administration complete recovery is rate can affect all ages Presentation Symptoms fever periorbital edema headache Physical symptoms cranial nerve palsies first involve CN VI as it runs through the middle of the sinus Evaluation Clinical diagnosis Complete blood count polymorphonuclear leukocytosis with left-shift (commonly) Blood culture CT and MRI with contrast preferred: CT first, then MRI get MRI with MR venography (imaging modality of choice) Differential Angle-closure glaucoma Orbital and periorbital infection Subarachnoid hemorrhage Treatment Broad-spectrum intravenous (IV) antibiotics penicillinase-resistant penicillin + 3rd or 4th generation cephalosporin Heparin controversial should be considered contraindicated in intracranial hemorrhage Corticosteroids should be considered if adrenal insufficiency results from cavernous sinus thrombosis, give corticosteroids prevents adrenal crisis Prognosis, Prevention, and Complications Prognosis decreased mortality with antibiotic administration