Infectious Disease Compendium

Cavernous sinus infections

Diagnosis

Headache and fevers, sometimes with unilateral swelling over the face.

Epidemiologic Risks

Chronic sinusitis, brain abscess and occasionally trauma. The sinuses lie next to cranial nerves III, IV, V, and VI and can impinge upon them with cause paralysis of the extraocular muscles and painful ophthalmoplegia.

Bacteria travel down the valveless veins of the face to the cavernous sinuses.

Microbiology

Variable. S. aureus, streptococci and anaerobes can all play a role (PubMed).

Empiric Therapy

Vancomycin PLUS metronidazole PLUS third generation cephalosporins is reasonable pending cultures; what ever you give should have good penetration into the CSF.

Anticoagulation is an important adjunctive therapy decreasing complications.

Pearls

Can be difficult to diagnosis without an MRI or high-resolution CT.

Rants

Last Update: 06/04/18.