背景:海绵窦血栓形成(CST)是一种严重的疾病,具有很高的发病率和死亡率。
目标:这篇综述突出了CST的珍珠和陷阱,包括介绍,诊断,并根据当前证据对急诊科(ED)进行管理。
结论:CST是一种涉及海绵窦的潜在致命性血栓性疾病。最常见的潜在病因是CST发展前几天的鼻窦炎或其他面部感染。尽管其他原因包括颌面部创伤或手术,血栓形成倾向,脱水,或药物。金黄色葡萄球菌,链球菌物种,口腔厌氧物种,革兰阴性杆菌是最常见的细菌病因。最常见的体征和症状是发烧,头痛,和眼部表现(化学,眶周水肿,上睑下垂,眼肌麻痹,视力变化)。颅神经(CN)VI是最常见的CN,导致侧直肌麻痹。其他可能受到影响的CNs包括III,IV,该疾病还可能影响肺和中枢神经系统。实验室检测通常显示炎症标志物升高,血液培养在高达70%的病例中是阳性的。在ED设置中,建议使用静脉造影延迟相位成像对头部和轨道进行计算机断层扫描,尽管磁共振静脉造影显示出最高的灵敏度。管理包括复苏,抗生素,和抗凝专家咨询。
结论:了解CST可以帮助急诊临床医生诊断和管理这种潜在的致命疾病。
BACKGROUND: Cavernous sinus thrombosis (CST) is a serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE: This review highlights the pearls and pitfalls of CST, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
CONCLUSIONS: CST is a potentially deadly thrombophlebitic disease involving the cavernous sinuses. The most common underlying etiology is sinusitis or other facial infection several days prior to development of CST, though other causes include maxillofacial trauma or surgery, thrombophilia, dehydration, or medications. Staphylococcus aureus, streptococcal species, oral anaerobic species, and gram-negative bacilli are the most frequent bacterial etiologies. The most prevalent presenting signs and symptoms are fever, headache, and ocular manifestations (chemosis, periorbital edema, ptosis, ophthalmoplegia, vision changes). Cranial nerve (CN) VI is the most commonly affected CN, resulting in lateral rectus palsy. Other CNs that may be affected include III, IV, and V. The disease may also affect the pulmonary and central nervous systems. Laboratory testing typically reveals elevated inflammatory markers, and blood cultures are positive in up to 70% of cases. Computed tomography of the head and orbits with intravenous contrast delayed phase imaging is recommended in the ED setting, though magnetic resonance venography demonstrates the highest sensitivity. Management includes resuscitation, antibiotics, and anticoagulation with specialist consultation.
CONCLUSIONS: An understanding of CST can assist emergency clinicians in diagnosing and managing this potentially deadly disease.