SCS (Cavernous Sinus Syndrome)

By | June 8, 2022

Cavernous sinus syndrome, also known as SCS, is characterized by loss of cranial nerves III, IV, and V1 and V2. The failure usually manifests itself in paralyzed eyesight. In addition to masses, thrombosis and aneurysms, trauma can also be considered as the cause.

What is SCS?

Human organs are supplied with blood by arterial blood vessels. Venous blood vessels return the circulating blood to the heart. The cavernous sinus is a venous blood conduit with a supply area in the brain. Its tributaries originate from the sphenoparietal sinus and the superior ophthalmic vein and the inferior ophthalmic vein. It drains via the inferior petrosal sinus and thus empties into the superior jugular vein bulb. For everything about heart attack, please visit

The cranial nerves III, IV and V1 as well as V2 run in the lateral wall of the vein. The sixth cranial nerve does not run in the lateral wall of the vein, but runs through the venous blood conductor. Cevernosus sinus syndrome is a neurological symptom complex characterized by the failure of these five cranial nerves. The result is multiple signs of paralysis. Paralysis of eye movement is considered the main feature of the disease. Loss of sensitivity of the cornea and upper facial areas or disturbances of consciousness are also characteristic of SCS.


The original trigger of the cavernous sinus syndrome is pressure damage to the anterior skull base. This damage causes a simultaneous partial or complete failure of the oculomotor nerve, the trochlear nerve and the abducens nerve. Sometimes the trigeminal nerve is also affected. The pressure damage usually corresponds to a cranial nerve compression, which can have various reasons. In addition to a septic or aseptic cavernous sinus thrombosis , tumors or cystic masses, for example, can cause the compression. Also cerebral aneurysms of the internal carotid arterycan be considered as the primary cause. Other conceivable triggers are carotid cavernous sinus fistula or hemorrhages. The latter can occur, for example, as a result of trauma or apoplexy. Cavernous sinus syndrome is also a characteristic symptom of Tolosa-Hunt syndrome, which has underlying inflammatory damage.

Symptoms, Ailments & Signs

Patients with cavernous sinus syndrome often complain of severe headaches in the cavernous sinus area. The clinical picture is also characterized by an oculomotor nerve palsy, a trochlear palsy and an abducens palsy. This means that those affected usually suffer from visual paralysis. The eyes roll, can no longer turn outwards or have high pressure values.

There are often additional sensory disturbances over the upper half of the face, which are due to the failure of the trigeminal branches V1 and V2. The severity of the symptoms varies with the underlying cause. Both unilateral and bilateral cases are known. Symptoms such as pulsatile exophthalmos may also present, depending on the primary trigger.

Fever or impaired consciousness can also occur depending on the cause. In some cases, those affected also suffer from a heteronymous hemianopsia. This is especially true after pressure damage to the optic chiasm, which is causally related to a pituitary tumor.

Diagnosis & course of disease

The diagnosis of cavernous sinus syndrome is made via a neurological examination. This finding is anchored in a functional test of the cranial nerves and trigeminal pressure points. Even the visual assessment of the deficits can provide important information and suggest an oculomotor nerve palsy, a trochlear palsy or an abductor palsy. As a rule, ophthalmoplegia or a failure of the corneal reflex confirms the suspicion of the neurological syndrome.

In order to clarify the cause of the symptom complex, a blood sample is required for laboratory diagnostics, which may reveal elevated inflammatory parameters and thus refer to the Tolosa-Hunt syndrome. A lumbar puncture for CSF diagnostics can also provide valuable information to secure the diagnosis and clarify the cause. Imaging procedures such as CT, MRI or cerebral angiography can rule out causative masses or, if necessary, confirm them.


Those affected suffer from a number of different complaints and complications with cavernous sinus syndrome. First and foremost, however, this leads to very severe and, above all, very frequent headaches. This pain also spreads to other parts of the body. This can lead to sleep problems and irritability in those affected, especially at night.

Many patients also suffer from visual disturbances and gaze paralysis. As a result, the development of those affected may be restricted and slowed down. Sensitivity disorders also occur due to illness. The paralysis is often felt on the face and can also lead to swallowing difficulties. As a result, normal intake of food and liquid is usually no longer possible for the patient.

Furthermore, those affected often suffer from fever and severe disturbances of consciousness. The development of tumors is also favored by the cavernous sinus syndrome. As a rule, only the symptoms of cavernous sinus syndrome are treated. There are no particular complications. However, it is not possible to limit the complaints completely. The syndrome may also reduce the life expectancy of the person affected.

When should you go to the doctor?

Since cavernous sinus syndrome does not heal itself, this disease must always be treated by a doctor. Proper treatment is the only way to prevent and limit further complications. A doctor should be consulted if the patient suffers from persistent and severe headaches.

This pain often spreads to the neighboring regions and leads to a significantly reduced quality of life for those affected. Sensitivity disorders can also indicate cavernous sinus syndrome and should always be examined by a doctor if they occur over a longer period of time. In some cases, cavernous sinus syndrome leads to fever. Since a tumor can also be responsible for the symptoms of the syndrome, regular examinations of the whole body should be carried out to prevent the tumor from spreading.

In the first place, a general practitioner can be consulted at the first signs of the syndrome. Further examination and treatment is then carried out by a specialist or in a hospital.

Treatment & Therapy

Treatment of cavernous sinus syndrome depends on the cause. If a thrombosis of the venous blood conductor is identified as the cause, then in most cases this is associated with a hematogenous spread of bacterial pathogens into the cavernous sinus. This can be caused by skin injuries on the upper lip, for example. The resulting thrombosis of the cavernous sinus is treated by the intravenous administration of antibiotics.

If, on the other hand, the cause is Tolosa-Hunt syndrome, intravenous treatment with high-dose corticosteroids is given instead of antibiotics. In the case of fistulas, tumors or cysts and aneurysms, the administration of medication for the causal treatment of the symptom complex is not sufficient. In these primary diseases, neurosurgical intervention is usually required to remove the mass. Cerebral aneurysms occupy a special position here, since their treatment is considered controversial due to the great risks.

The risk of bleeding during the procedure is relatively high. Aneurysms with a size of less than seven millimeters are therefore usually not treated. A neurosurgeon will only intervene if the location and size of the aneurysm, as well as the patient’s general condition and age, allow for comparatively low-risk intervention. If the cavernous sinus syndrome is due to bleeding as a result of trauma rather than an aneurysm, this bleeding can possibly be stopped or at least reduced with medication.


The cavernous sinus syndrome can hardly be prevented, since the symptom complex can appear in the context of numerous and fundamentally different phenomena. Trauma that is triggered in the context of accidents can hardly be avoided through preventive measures without losing quality of life.


Those affected by SCS usually only have a few and only limited measures and options for aftercare. For this reason, patients should consult a doctor as soon as the first symptoms and signs of the disease appear, so that further complications can be prevented. As a rule, no independent healing can occur, so that those affected are dependent on medical examination and treatment.

Most patients with this disease depend on various cosmetic procedures that can relieve the symptoms. These may have to be repeated more often, so that a complete limitation of the disease is not possible. Regular check-ups by a doctor are also very important.

If the disease is treated by surgery, those affected should take it easy after the operation and protect the affected region in particular. This can prevent infection and inflammation. It cannot be universally predicted whether SCS will lead to a reduced life expectancy of those affected.

You can do that yourself

Patients should pay attention to their lifestyle habits to improve their health. Although the possibilities of self-help cannot lead to a cure or recovery from the disease, there is the option of optimizing well-being and thereby making it easier to deal with the disease in everyday life.

If complaints arise, immediate action should be taken. Physical and mental overexertion should be avoided. In addition, the consumption of harmful substances such as alcohol and nicotine should be avoided. These can put additional strain on the organism and trigger an increase in symptoms. A rigid posture should always be avoided. The blood circulation is interrupted and can cause congestion of the blood. Numbness occurs and disorders of the musculoskeletal system set in.

The symptoms of the disease can include loss of vision, and the affected person is often dependent on the help of other people in everyday life. To avoid accidents or injuries, the structuring of daily responsibilities should be based on the patient’s capabilities. Dealing openly with the disease and clarifying questions are advisable so that adversities in dealing with other people are reduced to a minimum. Cooperation with a psychotherapist is recommended to stabilize mental strength and to cope with the illness.

SCS (Cavernous Sinus Syndrome)