Cavernous Sinus Syndrome
| Classification according to ICD-10 | |
|---|---|
| H49.8 | Other paralytic strabismus external ophthalmoplegia onA |
| ICD-10 online (WHO version 2019) | |
The cavernous sinus syndrome is a complex of neurological symptoms with multiple paralysis of the eye movements , occasionally severe headaches and loss of sensitivity of the cornea and upper facial areas. These are triggered within a vein space at the anterior skull base , the cavernous sinus , by pressure damage that causes the simultaneous, complete or partial failure of cranial nerves III ( oculomotor nerve ), IV ( trochlear nerve ) and VI ( abducens nerve ), and in some cases also V ( Trigeminal nerve ) causes.
root cause
The affected oculomotor cranial nerves all run along the lateral wall of the cavernous sinus and adjacent to the trigeminal nerve. A disorder is triggered by a compression of the nerve tracts, among other things caused by aneurysms of the internal carotid artery , thromboses , bleeding , tumors and other space-occupying processes as well as trauma .
Symptoms
The most conspicuous symptoms are the simultaneous paralysis of the eye muscles innervated by the three oculomotor cranial nerves with corresponding movement disorders , squint and double vision , which ultimately leads to total ophthalmoplegia . The disturbances can occur on one or both sides, depending on the extent and localization. If the trigeminal nerve is affected, the ophthalmic nerve and the maxillary nerve may have a lesion in the cornea and the upper parts of the face. Other clinical signs may occur in the form of pulsating exophthalmos , hemianopsias, and impaired consciousness.
Diagnosis
In addition to the neuro-ophthalmological clarification by means of a functional test of the affected eye muscles, a pressure test of the trigeminal nerve exit points is required as well as a sensitivity test of the cornea. In principle, all necessary neurological examinations ( liquor diagnostics , lumbar puncture , angiography, etc.) including imaging procedures ( computer tomography , magnetic resonance tomography ) are in the foreground to clarify the cause .
therapy
The treatment depends on the triggering factors. Neurosurgical interventions may be necessary for this, as may conservative treatments. Symptom-related interventions, such as squint operations , should only be discussed when the findings are stable over the long term.
Differential diagnosis
The cavernous sinus syndrome can be distinguished from the superior orbital fissure syndrome , which has very similar symptoms, by its localization .
history
It was first described in 1922 by the French neurologist Charles Foix , hence the (outdated) name Foix syndrome. This group of diseases includes other syndromes named after the first description, such as Jacod syndrome or Godtfredsen syndrome .
literature
- Peter Berlit (Ed.): Clinical Neurology. 2nd updated edition. Springer Medicine, Heidelberg 2006, ISBN 3-540-01982-0 .
- Theodor Axenfeld (founder), Hans Pau (ed.): Textbook of ophthalmology. 13th, completely revised edition. Gustav Fischer, Stuttgart et al. 1992, ISBN 3-437-00504-9 .
- Rudolf Sachsenweger (Ed.): Neuroophthalmology. 3rd, revised edition. Thieme, Stuttgart et al. 1983, ISBN 3-13-531003-5 .
Individual evidence
- ^ C. Foix: Syndrome de la paroi external du sinus caverneux (Ophtalmoplégie unilatérale à march rapidement progressive. Algie du territoire de l'ophtalmique). Amélioration considérable par le traitment radiothérapique. 1922 in: Rev Neur (Paris) 38, pp. 827-832
- ^ B. Leiber: The clinical syndromes. Syndromes, sequences and symptom complexes. Edited by G. Burg, J. Kunze, D. Pongratz, PG Scheurlen, A. Schinzel, J. Spranger, 7th edition. Urban & Schwarzenberg 1990, ISBN 3-541-01727-9
- ↑ J. J. van Overbeeke: The Cavernous Sinus Syndrome: An Anatomical and Clinical Study. In: M. Samii (Ed.): Surgery of the Sellar Region and Paranasal Sinuses , Springer, 1991, pp. 484-489, ISBN 978-3-642-76452-3 (print) 978-3-642-76450- 9 (online), doi : 10.1007 / 978-3-642-76450-9_77
