Cavernous Sinus Disease
Pathology in the cavernous sinus can cause injury to the following nerves:
- Oculomotor (CN III)
- Trochlear (CN IV)
- Abducens (CN VI)
There may also be associated paraesthesia in the distribution of the ophthalmic branch of the trigeminal nerve.
Cavernous sinus disease classically presents with a painful ophthalmoplegia. There is associated chaemosis (conjunctival oedema), proptosis (click on the image to enlarge), severe headache and sometimes a Horners syndrome.
Causes
Causes include:
- Tumours, for example lateral extension of a pituitary tumour, nasopharyngeal tumour and metastases
- Carotid-cavernous aneurysm
It can also occur as a complication of:
- Ethmoid, sphenoid or frontal sinus infection
- Orbital cellulitis
- Dental or midfacial infections
- Frontal abscess (CT image demonstrating ring-enhancing lesion in the frontal lobe – click on the CT to enlarge)
Approximately 5% of ophthalmoplegias are secondary to cavernous sinus pathology.