Comprehensive Epidemiology, Acute Care, Operative Intervention, and Nursing Management of Cavernous Sinus Thrombosis

Abstract

Background: Cavernous Sinus Thrombosis (CST) is a rare, life-threatening condition characterized by thrombotic occlusion of the cavernous sinus, a critical venous plexus at the skull base. It most commonly arises from the septic spread of infections originating in the face, sinuses, or orbits. Despite its rarity, CST carries a high risk of severe morbidity and mortality due to its proximity to crucial neurovascular structures, including cranial nerves and the internal carotid artery.

Aim: This article provides a comprehensive review of CST, aiming to synthesize current knowledge on its epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, and evidence-based management strategies to improve patient outcomes.

Methods: The study is a detailed narrative review, consolidating evidence from clinical studies, case series, and expert guidelines. It covers the anatomical basis, risk factors, microbiological etiology, and systematic approaches to diagnosis and treatment.

Results: CST typically presents with fever, severe headache, periorbital edema, chemosis, and ophthalmoplegia. Diagnosis is confirmed via contrast-enhanced MRI or CT venography. Management is multifaceted and requires immediate, broad-spectrum intravenous antibiotics, often combined with anticoagulation to prevent thrombus propagation. Surgical intervention may be necessary to address the primary source of infection. While modern management has significantly reduced mortality from historical rates of >80% to approximately 8-13%, long-term sequelae such as visual loss and persistent cranial nerve palsies remain common.

Conclusion: Successful outcomes depend on early recognition, rapid neuroimaging, and aggressive, multidisciplinary management involving antimicrobial therapy, anticoagulation, and surgical source control.