The Governor Vessel (GV)
Narda G. Robinson in Interactive Medical Acupuncture Anatomy, 2016
Cavernous sinus thrombosis typically occurs as a late complication of infection affecting the central portion of the face (in the danger triangle) or paranasal sinuses. Maxillary tooth or otic infection, bacteremia, and trauma can also cause cavernous sinus thrombosis. Without appropriate antimicrobial agents, intracranial septic thrombosis of the cavernous sinus may produce devastating complications due to the myriad neuro-vascular connections made in the sinuses. The internal carotid artery courses within the cavernous sinuses along with the sympathetic plexus that surrounds it. Cranial nerves supplying extraocular muscles, i.e., CN III, IV, and VI, follow its lateral walls. Trigeminal nerves from the ophthalmic and maxillary divisions travel within the walls.
Ophthalmology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in 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.
Emergency management of the complications of infective sinusitis
S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague in ENT Head & Neck Emergencies, 2018
Cavernous sinus thrombosis is well known for its rapid onset, severe morbidity and risk of death but is fortunately very rare. It presents with swelling of both eyes in a seriously ill, pyrexial patient. The complication develops as septic thrombi pass along the afferent venous system to the cavernous sinuses. Infection typically originates from a furuncle in the mid-face, but it can also arise from sepsis of the ethmoid, maxillary and sphenoid sinuses.
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
Superior ophthalmic vein thrombosis: A rare complication of Graves’ orbitopathy
Published in Orbit, 2018
Dante Sorrentino, Kenneth J Taubenslag, Lance M Bodily, Katherine Duncan, Tonya Stefko, Jenny Y Yu
In addition to symmetric inferior and medial rectus enlargement, orbital fat proliferation, and mild stretching of the optic nerves, maxillofacial CT revealed a dilated right superior ophthalmic vein (SOV) measuring 3.5 mm in diameter (Figure 3A) with enhancement of the vaso vasorum with central attenuation (Figure 3B, 3C) indicative of thrombus. Magnetic resonance imaging (MRI) brain and orbits with and without contrast as well as magnetic resonance angiography and venography were obtained to confirm the diagnosis and exclude cavernous sinus thrombosis as well as a carotid-cavernous fistula. MRI confirmed partially occlusive SOVT without extension to the cavernous sinus (Figure 4A, 4B). No signs of carotid-cavernous fistula were noted.