Cavernous Sinus Syndrome

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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

Cavernous sinus: internal carotid artery (red); Cranial nerves (yellow)

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 .


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.


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 .


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 .


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 .


Individual evidence

  1. ^ 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
  2. ^ 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
  3. 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