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Cavernous Sinus Thrombosis: Presentation, Management, and Initial Diagnostic Uncertainty
Emma J Anisman1, Lauren Colwell2, Joseph DeSimone2
1Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
The Laryngoscope
|August 4, 2026
Summary
Cavernous sinus thrombosis (CST) can be subtle and difficult to diagnose early. Recognizing symptoms like headache and neck pain, especially in younger patients, is crucial for timely intervention and preventing vision loss.
Area of Science:
- Neurology
- Radiology
- Ophthalmology
Background:
- Cavernous sinus thrombosis (CST) is a critical diagnosis that can be challenging to detect in its early stages.
- Subtle presentations without obvious orbital signs or clear radiographic indicators can lead to diagnostic delays.
Purpose of the Study:
- To analyze the largest single-institution series of cavernous sinus thrombosis (CST) cases.
- To characterize patient presentation, imaging findings, and surgical timing.
- To identify patterns associated with diagnostic uncertainty in early CST.
Main Methods:
- Retrospective cohort study of 33 patients diagnosed with CST based on imaging criteria.
- Defined initial diagnostic uncertainty (IDU) as patients discharged or transferred with an incorrect diagnosis.
- Analyzed clinical presentation, imaging patterns, treatment, and outcomes.
Main Results:
- 33% of patients experienced initial diagnostic uncertainty (IDU), often misdiagnosed as migraine or sinusitis.
- Neck pain was linked to delayed diagnosis (55% vs. 9.1%), and delayed patients were younger (40 vs. 64 years).
- Common symptoms included headache (63%), exophthalmos (53%), and cranial neuropathies (CNs). Imaging revealed sphenoid opacification (79%), superior ophthalmic vein thrombosis (50%), and bilateral CST (34%).
Conclusions:
- Suspicion for CST should be raised with sphenoid sinusitis accompanied by headache, CN palsies, orbital findings, or neck pain.
- Increased awareness of subtle presentations, particularly in younger individuals, and prompt intervention are key to preventing permanent visual impairment.
- Sinus surgery is vital for source control and obtaining cultures in CST management.
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