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Vol. 2 No. 2 (2025)

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January 24, 2026
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December 31, 2025

Copyright (c) 2025 Amani Khamash Hassan Asiri, Murdi Ali Naser Aldawsari, Abdurhman Majed Ali Aldawsari, Bader Fayz Mohammed Aldawsari, Misfer Marzooq Mohammed Aldawsari, Turki Mohammed Sultan Hakami, Abrar Sayer Almutairi, Maha Sameer Alanazi, Hani Ghazi Abdulmalik, Mohammed Abdulrahman Babaseel, Abed Abdullah Almetari D

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Multidisciplinary Evaluation and Management of Cavernous Sinus Thrombosis: Integrating Laboratory Diagnostics, Advanced Imaging, Epidemiologic Insights, and Primary Care Approaches

https://doi.org/10.64483/202522592
Amani Khamash Hassan Asiri
Al Harajah General Hospital, Ministry of Health, Saudi Arabia
Murdi Ali Naser Aldawsari
Wadi Al-Dawasir General Hospital, Ministry of Health , Saudi Arabia
Abdurhman Majed Ali Aldawsari
Wadi Al-Dawasir General Hospital, Ministry of Health , Saudi Arabia
Bader Fayz Mohammed Aldawsari
Wadi Al-Dawasir General Hospital, Ministry of Health , Saudi Arabia
Misfer Marzooq Mohammed Aldawsari
Wadi Al-Dawasir General Hospital, Ministry of Health , Saudi Arabia
Turki Mohammed Sultan Hakami
Samtah General Hospital – Jazan, Ministry of Health , Saudi Arabia
Abrar Sayer Almutairi
Second Health Cluster – Gulf Health Center 2, Ministry of Health , Saudi Arabia
Maha Sameer Alanazi
Public Health Department, Ministry of Health , Saudi Arabia
Hani Ghazi Abdulmalik
Maternity and Children Specialized Hospital – Jeddah, Ministry of Health , Saudi Arabia
Mohammed Abdulrahman Babaseel
Eastern Health Cluster – Al Khobar Health Network, Ministry of Health , Saudi Arabia
Abed Abdullah Almetari D
Eastern Health Cluster – Al Khobar Health Network, Ministry of Health , Saudi Arabia

Corresponding Author(s) : Amani Khamash Hassan Asiri

amani6511@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)

Abstract

Background:


Cavernous sinus thrombosis (CST) is a rare but lifethreatening neurovascular condition arising from infectious or aseptic etiologies. Its proximity to critical cranial nerves and the internal carotid artery contributes to rapid neurological and ophthalmologic deterioration when diagnosis and treatment are delayed. 


Aim: This study aims to synthesize multidisciplinary perspectives on CST—integrating epidemiology, risk factors, clinical features, diagnostic strategies, and management approaches—to support early identification and improve patient outcomes.


Methods: A comprehensive review of CSTrelated anatomy, pathophysiology, clinical presentation, imaging modalities, laboratory evaluation, and current therapeutic practices was conducted. Emphasis was placed on evidencebased antimicrobial therapy, anticoagulation strategies, surgical indications, and interprofessional care models. 


Results: CST occurs most frequently secondary to facial, sinus, or orbital infections, with Staphylococcus aureus being the most common pathogen. Key clinical features include fever, headache, periorbital edema, ophthalmoplegia, and cranial nerve palsies, with bilateral involvement often developing as thrombosis propagates. Contrastenhanced CT/MRI with venography provides the most reliable diagnostic confirmation. Early initiation of broadspectrum intravenous antibiotics, combined with anticoagulation when appropriate, significantly reduces mortality from historical levels exceeding 80% to approximately 10–30% today. Multidisciplinary management remains essential due to the high risk of visual loss and persistent cranial neuropathies. 


Conclusion: Timely, coordinated, and evidencebased intervention markedly improves survival and functional outcomes in CST. Despite advancements, morbidity remains significant, reinforcing the need for early recognition, prompt imaging, and integrated care strategies.

Keywords

Background: Cavernous sinus thrombosis (CST) is a rare but lifethreatening neurovascular condition arising from infectious or aseptic etiologies. Its proximity to critical cranial nerves and the internal carotid artery contributes to rapid neurological and ophthalmologic deterioration when diagnosis and treatment are delayed. Aim: This study aims to synthesize multidisciplinary perspectives on CST—integrating epidemiology, risk factors, clinical features, diagnostic strategies, and management approaches—to support early identification and improve patient outcomes. Methods: A comprehensive review of CSTrelated anatomy, pathophysiology, clinical presentation, imaging modalities, laboratory evaluation, and current therapeutic practices was conducted. Emphasis was placed on evidencebased antimicrobial therapy, anticoagulation strategies, surgical indications, and interprofessional care models. Results: CST occurs most frequently secondary to facial, sinus, or orbital infections, with Staphylococcus aureus being the most common pathogen. Key clinical features include fever, headache, periorbital edema, ophthalmoplegia, and cranial nerve palsies, with bilateral involvement often developing as thrombosis propagates. Contrastenhanced CT/MRI with venography provides the most reliable diagnostic confirmation. Early initiation of broadspectrum intravenous antibiotics, combined with anticoagulation when appropriate, significantly reduces mortality from historical levels exceeding 80% to approximately 10–30% today. Multidisciplinary management remains essential due to the high risk of visual loss and persistent cranial neuropathies. Conclusion: Timely, coordinated, and evidencebased intervention markedly improves survival and functional outcomes in CST. Despite advancements, morbidity remains significant, reinforcing the need for early recognition, prompt imaging, and integrated care strategies.
Asiri, A. K. H., Murdi Ali Naser Aldawsari, Abdurhman Majed Ali Aldawsari, Bader Fayz Mohammed Aldawsari, Misfer Marzooq Mohammed Aldawsari, Turki Mohammed Sultan Hakami, … Abed Abdullah Almetari D. (2025). Multidisciplinary Evaluation and Management of Cavernous Sinus Thrombosis: Integrating Laboratory Diagnostics, Advanced Imaging, Epidemiologic Insights, and Primary Care Approaches. Saudi Journal of Medicine and Public Health, 2(2), pp 3338–3347. https://doi.org/10.64483/202522592
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References
  1. Matthew TJH, Hussein A. Atypical Cavernous Sinus Thrombosis: A Diagnosis Challenge and Dilemma. Cureus. 2018 Dec 04;10(12):e3685.
  2. Eltayeb AS, Karrar MA, Elbeshir EI. Orbital Subperiosteal Abscess Associated with Mandibular Wisdom Tooth Infection: A Case Report. J Maxillofac Oral Surg. 2019 Mar;18(1):30-33.
  3. Dolapsakis C, Kranidioti E, Katsila S, Samarkos M. Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis. BMJ Case Rep. 2019 Jan 29;12(1)
  4. Chen MC, Ho YH, Chong PN, Chen JH. A rare case of septic cavernous sinus thrombosis as a complication of sphenoid sinusitis. Tzu Chi Med J. 2019 Jan-Mar;31(1):63-65.
  5. Kasha S, Bandari G. Bilateral Posterior Fracture-Dislocation of Shoulder Following Seizures Secondary to Cavernous Sinus Venous Thrombosis - A Rare Association. J Orthop Case Rep. 2018 Jul-Aug;8(4):49-52.
  6. DiNubile MJ. Septic thrombosis of the cavernous sinuses. Arch Neurol. 1988 May;45(5):567-72.
  7. Dinkin M, Patsalides A, Ertel M. Diagnosis and Management of Cerebral Venous Diseases in Neuro-Ophthalmology: Ongoing Controversies. Asia Pac J Ophthalmol (Phila). 2019 Jan-Feb;8(1):73-85.
  8. Torretta S, Guastella C, Marchisio P, Marom T, Bosis S, Ibba T, Drago L, Pignataro L. Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview. J Clin Med. 2019 Jan 16;8(1)
  9. Darmawan G, Hamijoyo L, Oehadian A, Bandiara R, Amalia L. Cerebral Venous Sinus Thrombosis in Systemic Lupus Erythematosus. Acta Med Indones. 2018 Oct;50(4):343-345.
  10. Mulvey CL, Kiell EP, Rizzi MD, Buzi A. The Microbiology of Complicated Acute Sinusitis among Pediatric Patients: A Case Series. Otolaryngol Head Neck Surg. 2019 Apr;160(4):712-719.
  11. Housley SB, McPheeters MJ, Raygor KP, Bouslama M, Scullen T, Davies JM. Cavernous Sinus Thrombosis. Neurosurg Clin N Am. 2024 Jul;35(3):305-310.
  12. Weerasinghe D, Lueck CJ. Septic Cavernous Sinus Thrombosis: Case Report and Review of the Literature. Neuroophthalmology. 2016 Dec;40(6):263-276.
  13. Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. Biology (Basel). 2022 Dec 08;11(12)
  14. Alam MS, Backiavathy V, Noronha V, Mukherjee B. Orbital abscess: 20 years' experience at a tertiary eye care center. Orbit. 2022 Dec;41(6):751-758.
  15. Berge J, Louail C, Caillé JM. Cavernous sinus thrombosis diagnostic approach. J Neuroradiol. 1994 Apr;21(2):101-17.
  16. Branson SV, McClintic E, Yeatts RP. Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature. Ophthalmic Plast Reconstr Surg. 2019 May/Jun;35(3):272-280.
  17. Deliran SS, Sondag L, Leijten QH, Tuladhar AM, Meijer FJA. [Headache: consider cavernous sinus thrombophlebitis]. Ned Tijdschr Geneeskd. 2018 Aug 16;162
  18. Fujikawa T, Sogabe Y. Septic cavernous sinus thrombosis: potentially fatal conjunctival hyperemia. Intensive Care Med. 2019 May;45(5):692-693.
  19. van der Poel NA, de Witt KD, van den Berg R, de Win MM, Mourits MP. Impact of superior ophthalmic vein thrombosis: a case series and literature review. Orbit. 2019 Jun;38(3):226-232.
  20. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006 Oct;26 Suppl 1:S19-41; discussion S42-3.
  21. Akarapas C, Wiwatkunupakarn N, Sithirungson S, Chaiyasate S. Anticoagulation for cavernous sinus thrombosis: a systematic review and individual patient data meta-analysis. Eur Arch Otorhinolaryngol. 2025 Mar;282(3):1127-1134.
  22. Wang YH, Chen PY, Ting PJ, Huang FL. A review of eight cases of cavernous sinus thrombosis secondary to sphenoid sinusitis, including a12-year-old girl at the present department. Infect Dis (Lond). 2017 Sep;49(9):641-646.
  23. Frank GS, Smith JM, Davies BW, Mirsky DM, Hink EM, Durairaj VD. Ophthalmic manifestations and outcomes after cavernous sinus thrombosis in children. J AAPOS. 2015 Aug;19(4):358-62.
  24. Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: A review. Surv Ophthalmol. 2021 Nov-Dec;66(6):1021-1030.
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