acute cavernous sinus thrombophlebitis
Introduction
Introduction to acute cavernous sinus embolic phlebitis Acute cavernous sinus embolism (acute cavernoussinusthrombophlebitis) is a severe cavernous sinus purulent inflammation, not treated in time, and the mortality rate is extremely high. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: cellulitis cellulitis acute cavernous sinus embolic phlebitis abscess meningitis
Cause
Causes of acute cavernous sinus embolic phlebitis
Bacterial infection (45%):
The disease is caused by a purulent bacterial infection. The most common pathogen is Staphylococcus aureus, accounting for 70% to 92%, as well as hemolytic streptococcus, Streptococcus pneumoniae and the like.
Autologous infection (55%):
The main infection route is the cavernous sinus caused by blood flow drainage in the septic embolism of adjacent suppurative infection, such as facial eyelid swelling, mumps, phlegm, erysipelas, cellulitis, sinusitis, tonsillitis, etc. , the supraorbital vein, the inferior vein enters the cavernous sinus; the throat infection is fused into the cavernous sinus via the wing vein; the otitis media, the suppurative inflammation of the mastoid sinus enters the cavernous sinus, and the other infection route directly spreads to the cavernous sinus, such as Sphenoid sinusitis, mastoiditis, etc., are scattered from distant purulent lesions to cavernous sinus.
Pathogenesis
This disease occurs in the eye, there are two common forms, one is suppurative inflammation, the surrounding structural inflammatory foci migrate through the blood vessels into the sputum, causing acute suppurative embolic phlebitis, clinical manifestations similar to septic cavernous sinus embolism or acute Cellulitis; the other type is mainly thrombosis. If it occurs in the ocular vein, the diameter of the vessel is thickened, the wall is thickened, and the inside is thrombus and chronic granulation tissue (Fig. 2A), accompanied by inflammatory cells. Infiltration, thrombus can also be an unstructured cellulose clot, full of blood vessels, hard vascular texture, full occlusion of the lumen, can also spread to the branches, old thrombus can be machined or recanalized.
Prevention
Prevention of acute cavernous sinus embolism
Early treatment of infected lesions on the face and its surroundings to prevent its spread.
Complication
Complications of acute cavernous sinus embolic phlebitis Complications, cellulitis, cellulitis, acute cavernous sinus embolism, abscess, meningitis
Cellulitis can cause embolism of cavernous sinus, and cavernous sinus embolism can also cause sputum cellulitis. The infection can be caused by the retrograde flow of the supraorbital vein, or the supracondylar fissure directly spreads to the eyelid. Therefore, cavernous sinus inflammation After the eyeball is still protruding, the possibility of abscess formation should be considered. In addition, diffuse meningitis can be complicated.
Symptom
Acute cavernous sinus embolization venous symptoms common symptoms high fever coma throat burning pain drowsiness
Patients often have a history of acute infection, acute onset, sudden high fever, headache, vomiting, lethargy or even coma, mild pain in the pharynx, edema and upper eyelids can be paralyzed and dilated, solid ocular veins, ocular surface blood vessel screws The varicose veins are centered and radially distributed, most of which start from the limbus until the dome disappears. Similar to the carotid-cavernous sinus fistula, the eye movement is slightly restricted, the vision can be reduced, and the fundus vein is dilated. This is caused by a backflow barrier.
Examine
Examination of acute cavernous sinus embolism
Blood tests are consistent with inflammatory diseases.
B-mode ultrasound can be seen in the expansion of the venous venous tubular shape, which lacks or rarely internal echo, no pulsation, oppression of the eyeball, this tubular anechoic band can not be locked; D-mode ultrasound exploration without color flow of the lumen, cavity In addition to the internalized blood clots, the avascular spectrum appears, which is also different from the carotid-cavernous sinus fistula. The CT scan of the supraorbital vein is dilated, curved, increased in density, and the extraocular muscles are slightly widened.
CT scan showed enlargement of one or both sides of the cavernous sinus, high density of soft tissue in the iliac crest, hypertrophy of the extraocular muscles, and prominent eyeballs.
Diagnosis
Diagnosis and differentiation of acute cavernous sinus embolism
The clinical diagnosis of this disease is difficult, and the typical records of B-ultrasound and CT can be clearly diagnosed.
At the beginning of the eye symptoms, it is similar to one side of the cellulitis. After a few hours, the inflammation spreads to the opposite side through the sinus space. Symptoms of both eyes appear, due to obstruction of the orbital venous return, circulatory disorders, eyelids, high conjunctival edema, and vein dilatation. The conjunctiva protrudes from the cleft palate, and even the conjunctival necrosis, the cleft palate becomes smaller, due to congestion in the sputum, soft tissue congestion and edema, increased intra-orbital pressure, prominent eyeballs, and ocular dyskinesia. Since the nerves pass through the cavernous sinus, the eyeball abduction first appears. Obstruction, when the eyeball is deflected inward, the oculomotor nerve, the trochlear nerve and the trigeminal nerve branch are involved, the eyeball is fixed, the cornea, the eyelid, the supraorbital area pain disappears, and the indirect light reflex disappears when the intraocular muscle is involved. , fundus vein dilatation, optic disc edema, decreased vision, due to eyeball protrusion, cleft palate can not be closed, eyeball fixation, corneal exposure, corneal ulcer, even corneal perforation, eyeball atrophy, carotid-cavernous sinus venous pressure only slightly elevated When the eyeball is oppressed, there is no vibration in the central retinal artery.
