Cavernous Sinus Syndrome

Cavernous sinus syndrome is a syndrome characterized by neuropathies of the cranial nerves passing through the cavernous sinus. 

The nerves passing through the cavernous sinus are:

• Occulomotor (III) 
• Trochlear (IV) 
• Ophthalmic (V1)
• Maxillary (V2) 
• Abducens (VI) 

The optic nerve (II) runs just above the cavernous sinus. 

A diagram illustrating the anatomy of the cavernous sinus is shown below: 

Presentation of cavernous sinus syndrome is with palsies of whichever cranial nerve is affected, such as impairment of eye movement or Horner’s syndrome. 

Causes of cavernous sinus syndrome include: 

• Infection 
• Bacterial – staph, strep, tuberculosis 
• Fungal 
• Viral 
• Vascular 
• Aneurysm of internal carotid artery 
• Thrombosis 
• Inflammation 
• Sarcoidosis
• Toloso-Hunt syndrome 
• SLE
• Neoplasia 
• Pituitary adenoma
• meningioma 
• mets – especially nasopharangeal carcinoma, lymphoma, meningioma, lung and breast metastases 

Treatment depends on the cause. 

References

Lee JH, et al. Cavernous sinus syndrome: clinical features and differential diagnosis with MR imaging. AJR Am J Roentgenol. 2003; 181(2):583-90. 

Sharkawi E, Tumuluri K, Olver JM. Metastastic choriocarcinoma causing cavernous sinus syndrome. Br J Ophthalmol. 2006; 90(5): 654-5. 

Zarei M, Anderson JR, Higgins JN, Manford MR. Cavernous sinus syndrome as the only manifestation of sarcoidosis. J Postgrad Med 2002;48:119