Cavernous sinus syndrome is a neurological symptom complex caused by compression of the casveranus sinus. The main symptoms are paralysis of the facial nerves, such as those of the eye muscles. Therapy depends on the primary disease in which the syndrome occurs.
What is cavernous sinus syndrome?
The cavernous sinus is part of the sinus durae matris. It is a venous blood conductor that supplies the brain. In addition to tributaries, the structure contains several cranial nerves. The oculomotor nerve (III cranial nerve), the trochlear nerve (IV cranial nerve), the ophthalmic nerve (V1 cranial nerve) and the maxillary nerve (V2 cranial nerve) run in the lateral wall of the blood conduit. The abducens nerve (VI. cranial nerve) runs directly through the sinus canvernosus. For kawasaki syndrome definitions, please visit definitionexplorer.com.
In cavernous sinus syndrome, these nerves are affected by failures. The result is various signs of paralysis in the facial area. The syndrome is a cranial nerve compression that has various causes and can therefore be present in the context of different primary diseases. The therapeutic approach to treating the syndrome depends on the cause or primary disease.
A special form and at the same time a possible cause of the cavernous sinus syndrome is the neurological symptom complex of the Tolosa-Hunt syndrome. This variant of the syndrome not only manifests itself in the typical gaze paralysis, but above all in severe pain.
The symptoms of cavernous sinus syndrome are caused by compression of the cavernous sinus. This compression may be associated with tumors of this structure, for example. Septic or aseptic thrombosis of the venous blood vessels can also compress the vein. An equally conceivable cause for the compression are cerebral aneurysms of the inflowing internal carotid artery.
Fistulas sometimes also form in the cavernous sinus or the carotid artery, which puts pressure on the blood vessels and the cranial nerve tracts located there. In addition, as a result of trauma or a apoplexy, bleeding can occur in the blood vessel, which can also have compressive properties. A much rarer cause is the inflammatory Tolosa-Hunt syndrome. In this neurological syndrome, compression of the cavernous sinus is caused by granulomatous inflammation in the bony skull. The ultimate cause of the inflammation has not yet been finally clarified.
Symptoms, Ailments & Signs
The clinical picture shows the cavernous sinus syndrome as a combination of facial nerve paralysis. Both oculomotor nerve palsies, trochlear palsies and abducens palsies are characteristic. These paralyzes are mainly paralysis of the eye muscles, which primarily result in gaze deviation, vertical gaze deviations and an inability to accommodate. In most cases, there are also sensory disturbances in the upper half of the face, which are caused by a failure of various branches of the trigeminal nerve on the ophthalmic nerve or the maxillary nerve.
The expression of the syndrome is either unilateral or bilateral. Especially with a cause such as Tolosa-Hunt syndrome, patients with cavernous sinus syndrome also often complain about sharp eyes – or headaches. Pulsatile exophthalmos may also develop, depending on the cause. In addition, heteronymous hemianopsia may be present if the optic chiasm is compressed by pituitary tumors, for example. Non-specific accompanying symptoms are fever and disturbances of consciousness.
Diagnosis & course of disease
When diagnosing cavernous sinus syndrome, the primary requirement is to specify the cause. The syndrome itself can already be diagnosed in the context of visual findings. The specification requires more complex diagnostics. A functional test of the cranial nerves and trigeminal pressure points is used as a neurological diagnosis.
Ophthalmoplegia and a loss of the corneal reflex can be observed in patients with cavernous sinus syndrome. To clarify the cause, blood is also taken from those affected, which is then examined for inflammatory parameters in the laboratory. A lumbar puncture followed by CSF diagnostics can indicate malignant or inflammatory processes in the central nervous system and thus further specify the diagnosis.
Imaging methods such as CCT, MRT or cerebral angiography help to rule out tumors and cysts as a cause. The prognosis for cavernous sinus syndrome depends on the cause. For example, patients with Tolosa-Hunt syndrome have a better prognosis than cancer patients.
First and foremost, cavernous sinus syndrome causes very severe headaches. This pain often spreads to the neighboring regions, so that there can also be pain in the teeth or ears. Furthermore, those affected suffer from a gaze paralysis, so that a usual movement of the eyes or the eyelids is no longer easily possible.
Sensitivity disorders can also occur in the face and have a very negative effect on the quality of life of those affected. Fever and tiredness and exhaustion of the patient often occur. Due to the constant pain, many of those affected suffer from sleep disorders and thus from irritability or depression. Disorders of consciousness or further loss of consciousness can also occur.
Treatment of cavernous sinus syndrome always focuses on the root cause. It usually runs without complications, although in some cases surgical interventions are necessary. In most cases, after the treatment, the disease progresses positively and all symptoms are reduced. The life expectancy of the patient is not negatively affected by the cavernous sinus syndrome.
When should you go to the doctor?
Cavernous sinus syndrome must always be treated by a doctor. This disease can lead to serious symptoms and complications, which in the worst case can even lead to the death of the person concerned. For this reason, a doctor must be consulted at the first sign of cavernous sinus syndrome. The earlier the disease is detected, the better the further course is, as a rule. A doctor should be consulted if the patient experiences severe pain in the neck and head.
A persistent and, above all, severe fever can also indicate cavernous sinus syndrome and should also be examined. Most patients suffer from sensory disorders and various sensory disorders, which can also lead to severe visual problems, which limit the patient’s everyday life. If these symptoms occur, a doctor must be consulted immediately.
Cavernous sinus syndrome can be treated relatively well by a cardiologist. In emergencies or in the event of an epileptic seizure, you should call an ambulance or go to the hospital. Self-healing cannot occur in cavernous sinus syndrome. This disease may also reduce the life expectancy of those affected.
Treatment & Therapy
Like the prognosis, the treatment of cavernous sinus syndrome also depends on the cause. In the case of causes such as tumors or cysts, a causal treatment of the symptoms can take place. This causative therapy usually corresponds to surgical intervention, in which the surgeon removes the compressing growth. An intervention may also need to take place if the syndrome has been preceded by bleeding or thrombosis.
Intravenous antibiotics can sometimes help with thrombosis. In the case of causes such as Tolosa-Hunt syndrome, on the other hand, there is no causal therapy available, since the final etiology of the phenomenon has not yet been clarified. Therefore, with this symptom complex, symptomatic treatment of the cavernous sinus syndrome takes place. Usually, the patients are given intravenous corticosteroids, which allow the symptoms to remit after an average of three to five days.
If there is no remission or if the cranial nerves have suffered permanent damage in the case of tumors and cysts, supportive symptomatic therapy with eye movement training is carried out. Targeted movements can ideally compensate for the damage or the patient at least learns to deal with it. This improves his quality of life.
With causes such as Tolosa-Hunt syndrome, cavernous sinus syndrome cannot be prevented. If the neurological symptom complex can be prevented at all, then only in connection with thrombosis, trauma and possibly fistulas.
In most cases, those affected by cavernous sinus syndrome have no direct or special measures for direct aftercare. Since this disease is a congenital disease, it usually cannot be completely cured.
In order to prevent the recurrence of cavernous sinus syndrome in descendants, those affected should have a genetic examination and counseling carried out if they wish to have children. Self-healing cannot occur with this disease, whereby the affected person should first and foremost consult a doctor very early on so that early treatment can take place.
As a rule, most symptoms of this disease can be alleviated relatively well by taking various medications. The person concerned should always pay attention to regular intake and also to the correct dosage. If anything is unclear or if you have any questions, you should first contact a doctor, who should also be consulted in the event of severe side effects. Likewise, many of those affected depend on the help and care of their own families in their everyday lives. This may also prevent depression and other mental upsets.
You can do that yourself
In everyday life, the risk of accidents for those affected is significantly increased due to visual paralysis. It is therefore important to ensure that sufficient help and support is accepted. Cooperation with a doctor should be sought as soon as the first health problems appear. Self-help measures are not enough to achieve freedom from symptoms or to significantly alleviate the symptoms.
The symptoms particularly affect the facial area. For this reason, in addition to the physical complaints, there are often states of emotional stress. A healthy self-confidence should be built up so that the risks of psychological complications are minimized. The social environment should be informed about the disease and its symptoms. This can reduce unpleasant situations or misunderstandings to a minimum.
Since the occurrence of headaches is characteristic of the disease, stressors of all kinds should be reduced. These could otherwise contribute to a worsening of the situation. Relaxation techniques and the use of mental techniques are also helpful. For a large number of those affected, the use of mental techniques can improve the symptoms. In addition, it is often reported that the handling of the disease is improved as a result. If you have a fever, make sure you drink enough fluids. Dehydration should be avoided at all costs.