Complications
Mortality has decreased from 80% to 100% in the pre-antibiotic era to 20% to 30% at the present time.[1][4]
The decrease in mortality rate is owing to early diagnosis of infection and rapid treatment with intravenous antibiotics, the most important factor to alter the prognosis of the disease.[2] In addition, surgical management of the primary source of infection (e.g., endoscopic sinus surgery), lowers mortality.[12][13][14]
Presents with fever, chills, nuchal rigidity, and mental status changes.
Diagnosis can be made with lumbar puncture and cerebrospinal fluid analysis.
Anticoagulation carries the risk of haemorrhage, especially in patients with concomitant complications, such as cortical venous infarction, necrosis of intra-cavernous portions of the carotid artery, or cerebral or intra-orbital haemorrhages.[50]
Close monitoring of the activated partial thromboplastin time (aPTT) is required during therapy.
The aPTT should be maintained between 1.5 to 2.0 times normal.[15]
If a patient is considered suitable for anticoagulation but deteriorates despite this therapy, they may be considered for endovascular therapy.[87][88][89] Although endovascular treatment is increasingly being used to treat patients with cerebral venous thrombosis, this treatment is not routinely recommended in all patients.[90] This therapy is usually reserved for progressive, aseptic CST and carries with it the risks of intracranial haemorrhage and stroke and the inability to re-canalise.
Thrombosis can extend to the other dural venous sinuses, depending on the site and extent of involvement.[57]
Leads to stroke.
Can occur secondary to carotid thrombosis with subsequent stroke.
Can occur secondary to carotid thrombosis with subsequent stroke.
The presentation of intracranial abscesses have been reported to occur up to 8 months after cavernous sinus thrombosis (CST).[57][96]
Choice of antibiotics in the presence of brain abscess is usually meropenem alone.
Duration of treatment in the presence of such a complication should be extended to at least 6 to 8 weeks.[1]
Aspiration of such abscesses is usually required.
Craniotomy, with excision of the abscess, may also be needed if the patient's condition deteriorates.[96]
Can occur acutely, requiring immediate treatment with corticosteroids, and may be life-threatening.[91]
If suspected, then replacement should be started immediately while waiting for laboratory confirmation.[91]
Has been reported to occur as a long-term complication at 4 years after diagnosis of CST, with manifestations of hypothyroidism and hypo-gonadism.[100]
Occurs as a complication of the disease.
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