Septic cavernous and lateral sinus thrombosis: modern diagnostic and therapeutic principles

The incidence of both lateral and cavernous sinus thrombophlebitis has been significantly reduced in the antibiotic era. Since septic cavernous sinus thrombosis (CST) is mainly a complication of facial abscesses and septic lateral sinus thrombosis (LST) is almost invariably due to chronic otitis media, both conditions are of clinical relevance to the otolaryngologist. The predominant bacterium in septic CST is Staphylococcus aureus whereas in septic LST the bacteriology is very similar to that found in chronic otitis media. The diagnosis of septic CST can be established in most cases after thorough clinical examination, and contrast computerized tomography (CT) using the coronal projection usually confirms the clinical diagnosis. The signs and clinical course of septic LST are non-specific and the final diagnosis rests upon radiological investigations including CT-scan. The treatment of both conditions consists of broad-spectrum antibiotics, including beta-lactamase resistant penicillin in cases of septic CST. Most cases of septic LST also require surgical intervention. Two cases of septic intracranial sinus thrombosis are presented. The need for early diagnosis and treatment of this potentially lethal condition is emphasized.