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Infection-Associated Ocular Cranial Nerve Palsies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar, Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal
The cavernous sinus is a dural venous sinus, one on either side, situated on the body of sphenoid bone of the brain extending from the medial end of superior orbital fissure to the petrous portion of the temporal bone (3). It is related to pituitary gland and sphenoid sinus medially and to the temporal bone laterally. Importantly, the ocular motor nerves, trigeminal nerve, and internal carotid artery pass through the cavernous sinuses. While oculomotor, trochlear, and trigeminal (V1/2) nerves travel through the lateral walls of cavernous sinus, the abducens nerve and the post-ganglionic sympathetic nerve fibers travel through the core of the cavernous sinus (Figure 16.5).
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
These include: Orbital cellulitis: usually secondary to ethmoiditis (Fig. 7.60). In severe cases there may be visual compromise and/or development of cavernous sinus thrombosis. Orbital and brain imaging is essential. Treatment includes ENT assessment, intravenous antibiotics and abscess drainage. Prognosis is usually good. Pseudotumour: idiopathic orbital inflammation that usually affects children between 6 and 14 years. If it is bilateral, Wegener’s granulomatosis must be excluded. Orbital imaging is essential. Treatment is usually with steroids orally.Thyroid eye disease: may be seen in children and is associated with lid retraction. Surveillance for optic neuropathy is essential but very rare.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The superficial middle cerebral vein drains the lateral surface of the brain and ends in the cavernous sinus. A superior anastomotic vein connects the superficial middle cerebral vein to the superior sagittal sinus, and an inferior anastomotic vein connects it to the transverse sinus.
Cavernous sinus haemangioma masquerading as a pituitary macroadenoma: how the unexpected lurks in neurosurgery
Published in British Journal of Neurosurgery, 2023
Simon Lammy, Jennifer Brown, Patricia Littlechild
Common locations include the middle cranial fossa, pituitary fossa, optic chiasm, cavernous sinus, Vth and VIIth cranial nerves, cerebello-pontine angle and ventricles.1–3 Therefore, symptoms include headache, and those attributable to cavernous sinus and chiasmal syndromes.2–5 Signs are insidious due to their quiescent nature5 and include ptosis1,2, diplopia1,2, decreased visual acuity, visual field defects, obesity, amenorrhoea and facial numbness and neuralgia due to Gasserian ganglion involvement.2,4 Further anatomical sub-locations include Parkinson’s triangle between IVth and V1 and Mullan’s triangle between V1 and V22. This contrasts CCMs that usually present in a haemorrhagic fashion (25%) displaying both focal neurological deficits and seizures. Less than 1% of CSH present as a haemorrhage despite being highly vascular.1–5
Orbital abscess: 20 years’ experience at a tertiary eye care center
Published in Orbit, 2022
Md Shahid Alam, Varsha Backiavathy, Veena Noronha, Bipasha Mukherjee
Sight-threatening complications included optic neuropathy in 15 patients (44.12%), orbital apex syndrome in 4 patients (11.76%), central retinal occlusion, exposure keratopathy in two patients each (5.88%), and panophthalmitis in one (2.94%). Optic neuropathy was diagnosed based on the assessment of optic nerve function tests such as visual acuity, color vision, pupillary examination and fundus evaluation. Sight-threatening complications were seen in 80% (n = 12) of adults and 63.16%(n = 12) of children. Life-threatening complications were noted in four patients (11.77%), three in children and one in an adult. Cavernous sinus thrombosis was diagnosed in two patients (5.88%), epidural abscess and septicemia were seen in one (2.94%) each. The abscesses were located in the intraconal space in five (14.70%) patients, extraconal space in 26 (76.47%), while three (8.82%) had involvement of both the spaces with diffuse orbital involvement. The breakup of the locations of abscesses in the extraconal space was as follows, 11 in the superomedial space, seven in the inferior space, six in the superior space, four in the lateral space, and two in the superolateral space. Multiple abscesses were seen in seven patients, of whom three comprised the ones with diffuse involvement and the other four were multiple extraconal abscesses.
Imaging findings in invasive rhino-orbito-cerebral mucormycosis in post–COVID-19 patients
Published in Baylor University Medical Center Proceedings, 2022
Gunjan Jindal, Aaftab Sethi, Kanika Bhargarva, Sanjay Sethi, Amit Mittal, Ujjwala Singh, Shreya Singh, Amit Shrivastava
On imaging, aggressive sinonasal and orbital changes caused by the disease have been seen by Mnif et al and Herrera et al.5,6 Many studies have shown that cavernous sinus thrombosis and vascular complications of the disease can be detected by MRI. Cavernous sinus involvement appears hypointense on T1 and T2 with intense inhomogeneous postcontrast enhancement. Contrast-enhanced computed tomography and MRI are the best imaging modalities for the detection of Mucor.7 In our study, contrast-enhanced MRI of the brain, orbits, and paranasal sinuses was done for all 15 cases. As Silverman et al described, the presence of retroantral, facial, and orbital fat stranding indicates the aggressive nature of the infection. Periantral fat stranding was present in 10 patients, and 7 patients showed infratemporal fossa fat stranding; only 2 patients showed extension into the pterygopalatine fossa.8