Cavernous Sinus Syndrome

The Cavernous Sinus Syndrome is a complex of neurological symptoms caused by compression of the cerebral sinus casvernosus. 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 symptoms of cavernous sinus syndrome are caused by compression of the cavernous sinus. This compression can be associated with tumors of this structure, for example.
© olgadanilina - stock.adobe.com Of the Cavernous sinus counts to Sinus durae matris. It is a venous blood conductor that supplies the brain. In addition to tributaries, the structure contains several cranial nerves. The run in the side wall of the blood conductor Oculomotor nerve (III.Hirnnrev), the Trochlear nerve (IV. Cranial nerve), the Ophthalmic nerve (V1. Cranial nerve) and the Maxillary nerve (V2. Cranial nerve). Straight through the Sinus canvernosus runs the Abducens nerve (VI. Cranial nerve).

At the Cavernous Sinus Syndrome these nerves are affected by failures. The result is various symptoms of paralysis in the face. The syndrome is a cranial nerve compression that has various causes and can therefore be present in the context of various 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 Tolosa-Hunt syndrome. This variant of the syndrome manifests itself not only in the typical paralysis of the eyes, but above all in severe pain.

causes

The symptoms of cavernous sinus syndrome are caused by compression of the cavernous sinus. This compression can be associated with tumors of this structure, for example. Septic or aseptic thrombosis of the venous blood conduit can also compress the vein. Another conceivable cause of the compression are cerebral aneurysms of the inflowing Internal carotid artery.

Sometimes fistulas also form on the cavernous sinus or the carotid artery, which put pressure on the bloodstream and the cranial nerve tracts located there. As a result of trauma or apoplexy, bleeding can also occur in the blood line, which can also have compressive properties. A much less common cause is the inflammatory Tolosa Hunt syndrome. In this neurological syndrome, the compression of the cavernous sinus is caused by granulomatous inflammation in the bony skull. The ultimate cause of the inflammation has not yet been conclusively clarified.

Symptoms, ailments & signs

In the clinical picture, the cavernous sinus syndrome appears as a combination of facial nerve paralysis. Both oculomotor pareses and trochlear palsies and abducens pareses are characteristic. These paralyzes are predominantly eye muscle paralysis, which mainly result in deviations in gaze, vertical gaze deviations and inability to accommodate. Usually there are also sensory disorders of the upper half of the face, which are caused by the failure of various trigeminal branches on the ophthalmic or maxillary nerve.

The severity of the syndrome is either unilateral or bilateral. Especially with a cause such as Tolosa Hunt Syndrome, patients with cavernous sinus syndrome often also complain of sharp eye or headaches. Depending on the cause, pulsating exophthalmos can also occur. In addition, a heteronymous hemianopia may be present if the optic chiasm is compressed by pituitary tumors, for example. Nonspecific accompanying symptoms are fever and impaired consciousness.

Diagnosis & course of disease

When diagnosing cavernous sinus syndrome, it is particularly important to specify the cause. The syndrome itself can be diagnosed by looking at it. The specification requires more complex diagnostics. A functional test of the cranial nerves and trigeminal pressure points is used as a neurological diagnosis.

In patients with cavernous sinus syndrome, ophthalmoplegia and a failure of the corneal reflex can be determined. To clarify the cause, blood is also taken from those affected, which is examined in a laboratory for inflammation parameters. A lumbar puncture with subsequent CSF diagnostics can provide indications of malignant or inflammatory processes in the central nervous system and thus further specify the diagnosis.

Imaging procedures such as CCT, MRT or cerebral angiography help to exclude tumors and cysts. The prognosis for cavernous sinus syndrome depends on the cause. For example, patients with Tolosa Hunt Syndrome have a more favorable prognosis than cancer patients.

Complications

First and foremost, cavernous sinus syndrome leads to very severe headaches. This pain often spreads to the neighboring regions, so that pain can also occur in the teeth or ears. Furthermore, those affected suffer from eye paralysis, so that the usual movement of the eyes or eyelids is no longer possible.

Sensitivity disorders can also occur in the face and have a very negative effect on the quality of life of the person concerned. Likewise, there is often a fever and fatigue and exhaustion of the patient. Because of the constant pain, many sufferers suffer from insomnia and thus from irritability or from depression. Likewise, there may be disturbances of consciousness or further loss of consciousness.

Treatment of cavernous sinus syndrome is always based on the root cause. It usually proceeds without complications, although surgical interventions are necessary in some cases. In most cases, the disease progresses positively after the treatment and all symptoms are reduced. The life expectancy of the patient is not negatively influenced 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 complaints and complications, which in the worst case can even lead to the death of the person concerned. For this reason, in the case of cavernous sinus syndrome, a doctor must be consulted at the first signs. The earlier the disease is recognized, the better the further course will usually be. A doctor should be consulted if the patient experiences severe pain in the neck and head.

A permanent and, above all, severe fever can also indicate cavernous sinus syndrome and should also be investigated. Most patients suffer from disorders of sensitivity and various sensory disorders, which can also lead to severe visual problems, which limit the patient's everyday life. If these complaints occur, a doctor must be consulted immediately.

Cavernous sinus syndrome can be treated relatively well by a cardiologist. In an emergency or an epileptic fit, an emergency doctor should be called or the hospital should be visited. The cavernous sinus syndrome cannot heal itself. This disease may also reduce the life expectancy of the person affected.

Therapy & Treatment

Like the prognosis, therapy for cavernous sinus syndrome also depends on the cause. In the case of causes such as tumors or cysts, causal treatment of the symptoms can take place. This causal therapy usually corresponds to a surgical intervention in which the surgeon removes the compressive growth. Intervention may also have to take place if the syndrome was preceded by bleeding or thrombosis.

Sometimes intravenous antibiotics can help with a thrombosis. In the case of causes such as Tolosa-Hunt syndrome, however, there is no causal therapy available, since the ultimate etiology of the phenomenon has not yet been clarified. Therefore, with this complex of symptoms, a symptomatic treatment of the cavernous sinus syndrome takes place. Usually, the patient is given intravenous corticosteroids, which allow the symptoms to remission after three to five days on average.

If there is no remission or if the cranial nerves have suffered permanent damage in tumors and cysts, supportive symptomatic therapy with eye movement training is carried out. The damage can ideally be compensated for through targeted movements or the patient at least learns to deal with them. So his quality of life increases again.

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prevention

With causes such as Tolosa Hunt Syndrome, cavernous sinus syndrome cannot be prevented. If the neurological symptom complex is to be prevented at all, then only in connection with thrombosis, trauma and possibly fistulas.

Aftercare

In most cases, those affected with cavernous sinus syndrome have no direct or special follow-up measures available. Since this disease is a congenital disease, it usually cannot be completely cured.

In order to prevent the recurrence of the cavernous sinus syndrome in the descendants, those affected should have a genetic examination and advice carried out if they want to have children. Self-healing cannot occur with this disease, whereby the person affected should first and foremost consult a doctor very early on so that treatment can take place early.

As a rule, most of the symptoms of this disease can be relieved relatively easily by taking various medications. The person concerned should always ensure that they are taken regularly and that the dosage is correct. If anything is unclear or if you have any questions, you should first contact a doctor, who should also be consulted if there are 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 psychological upsets.

You can do that yourself

In everyday life, the risk of accidents for those affected is considerably increased due to paralysis. It is therefore important to ensure that sufficient help and support is accepted. Collaboration with a doctor should be sought as soon as the first health impairment occurs. The self-help measures are not sufficient to achieve freedom from symptoms or significant alleviation of the symptoms.

The symptoms particularly affect the face area. For this reason, in addition to physical complaints, there are often states of emotional stress. A healthy self-confidence should be built up so that the risks for 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 headaches are characteristic of the disease, all kinds of stressors should be reduced. Otherwise, these could worsen the situation. Relaxation procedures 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. It is also often reported that this improves the management of the disease. If you have a fever, make sure that you drink enough fluids. Dehydration should be avoided at all costs.