[Clinical and imaging features and etiologic diagnosis value in patients with cavernous sinus lesion presenting with...

Objective: To classify different causes of cavernous sinus lesion in patients with ophthalmoplegia and analyze their clinical and imaging features. Methods: We confirmed the etiological diagnosis of 137 hospitalized ophthalmoplegia patients with cavernous sinus lesion retrospectively from January 2005 to January 2014 in the Department of Neurology of Beijing Tongren Hospital.The diagnosis was made according to clinical feature, laboratory test, imaging studies and pathology.The clinical data of these patients were analyzed and compared among different groups. Results: Fifty-one cases (37.2%) were confirmed as inflammatory diseases of cavernous sinus, which were the most common cause in 137 patients.Early stage pain (OR 5.591, 95%CI 1.703-18.401) and involvement of oculomotor nerve (OR 4.902, 95%CI 1.015-24.630) were independently associated with inflammatory diseases.Forty-three cases (31.3%) were confirmed to have tumor, which was the second cause of cavernous sinus lesions, and meningioma was the most common tumor.The second branch of trigeminal nerve involvement was independently correlated (OR 1.017, 95%CI 1.005-1.071) with tumor.The percentage of male (OR 3.506, 95%CI 1.362-8.765) was significantly higher in 28 cases (20.4%) with cavernous sinus vascular lesions.Cavernous sinus infectious diseases were seen in 15 cases (10.9%), and fungal infection was the most common, mostly secondary to sinus infection. Conclusions: The common causes of cavernous sinus lesion include cavernous sinus inflammatory diseases, neoplastic diseases, vascular diseases and infectious diseases, and inflammatory diseases is the most commonly seen cause in this group of patients.Obvious facial sensory disturbances and the second branch of trigeminal nerve involvement are independent associated with tumor.The early course of pain and involvement of oculomotor nerve are associated with inflammatory diseases.Optimization of MRI examination method can better identify the cavernous sinus lesions.