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Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Cavernous sinus (V1, V2)/superior orbital fissure (V1): Aneurysm of carotid siphon or ophthalmic artery.Carotid–cavernous fistula.Cavernous sinus thrombosis.Sarcoidosis.Tolosa–Hunt syndrome: a rare condition that manifests as subacute onset of severe unilateral orbital pain which may be accompanied by a sensory disturbance in V1 and sometimes V2 distribution, and ocular motor (III, IV, and VI cranial) nerve palsies. It is caused by a chronic inflammation behind and/or within the orbit.Infectious etiologies.Tumors (Figure 21.7).
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Cavernous sinus thrombosis is a type of cerebral venous thrombosis, in which the blood clot is located in the cavernous sinus. The most common precipitating factor is infection of the nose, sinuses, teeth or eyes that spreads directly to the cavernous sinus.
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.
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
Computed Tomography Angiography of Bilateral Intracavernous Internal Carotid Artery Aneurysms
Published in Neuro-Ophthalmology, 2018
Ayman G. Elnahry, Gehad A. Elnahry
Bilateral intracavernous internal carotid artery aneurysms are rare and more commonly diagnosed in elderly females.1 In old age, it is usually associated with hypertension.2 Other causes include infections leading to mycotic aneurysms. Differential diagnosis includes cavernous sinus lesions as cavernous sinus thrombosis, carotico-cavernous fistula, and intracranial neoplasms. Intracavernous internal carotid artery aneurysms can present to neurologists, ophthalmologists, and rarely otolaryngologists depending on their manifestations. Most commonly, cranial nerve palsies and facial pain are the presenting symptoms due to the mass effect of the aneurysm, and in most cases, there is a progressive onset of symptoms.3 Although rupture of an intracavernous carotid aneurysm is rare, treatment is still indicated as it can result in significant improvement in symptoms.4,5 The preferred method of treatment is the endovascular approach, since it is both safe and effective.4