What are Cavernous sinus tumour symptoms? My sister has severe headaches with reddish watery eyes. MRI showing heterogeneous enhancements on both sides of cavernous sinus.

Question

Cavernous sinus syndrome is characterized by multiple cranial neuropathies. The clinical presentation includes impairment of ocular motor nerves, Horner's syndrome, and sensory loss of the first or second divisions of the trigeminal nerve in various combinations. The pupil may be involved or spared or may appear spared with concomitant oculosympathetic and parasympathetic involvement. Various degrees of pain may be involved The symptoms and signs of cavernous sinus disease are ophthalmoplegia, orbital congestion and proptosis, trigeminal sensory loss, and sympathetic disturbance. Sympathetic fibres join the abducens nerve for a short distance and thus a Horner?s syndrome in conjunction with 6th nerve palsy is of precise localising value. Cavernous sinus pathology accounts for 5% of all cases of ophthalmoplegia. Causes can be divided into vascular (aneurysms, fistulas, and thrombosis), tumours, and mis-cellaneous inflammatory disorders (including THS). Cavernous sinus tumours are the most common cause of the cavernous sinus syndrome. These may be metastatic (from lung, breast, prostate, etc), result from local spread (naso- pharyngeal, pituitary, craniopharyngioma), or be primary tumours (meningioma, neurofibroma). Pituitary tumours can invade one or both cavernous sinuses adjacent to the pituitary gland. Here ophthalmoplegia is associated with more longstanding endocrine symptoms of acromegaly, galactorrhoea, or hypopituritism. Unilateral or bitemporal visual field defects often coexist. Meningiomas involving the cavernous sinus may start in the sinus or grow into it as an extension from a larger tumour involving the medial sphenoid wing, orbit, clivus, or petrous bones. Natural history in some patients may be that of minimal or no growth for long periods of time; given the risk of significant cranial nerve morbidity with surgical treatment, management decisions are difficult.

Pradeep R K A · Accepted Answer

Cavernous sinus syndrome is characterized by multiple cranial neuropathies. The clinical presentation includes impairment of ocular motor nerves, Horner's syndrome, and sensory loss of the first or second divisions of the trigeminal nerve in various combinations. The pupil may be involved or spared or may appear spared with concomitant oculosympathetic and parasympathetic involvement. Various degrees of pain may be involved The symptoms and signs of cavernous sinus disease are ophthalmoplegia, orbital congestion and proptosis, trigeminal sensory loss, and sympathetic disturbance. Sympathetic fibres join the abducens nerve for a short distance and thus a Horner?s syndrome in conjunction with 6th nerve palsy is of precise localising value. Cavernous sinus pathology accounts for 5% of all cases of ophthalmoplegia. Causes can be divided into vascular (aneurysms, fistulas, and thrombosis), tumours, and mis-cellaneous inflammatory disorders (including THS). Cavernous sinus tumours are the most common cause of the cavernous sinus syndrome. These may be metastatic (from lung, breast, prostate, etc), result from local spread (naso- pharyngeal, pituitary, craniopharyngioma), or be primary tumours (meningioma, neurofibroma). Pituitary tumours can invade one or both cavernous sinuses adjacent to the pituitary gland. Here ophthalmoplegia is associated with more longstanding endocrine symptoms of acromegaly, galactorrhoea, or hypopituritism. Unilateral or bitemporal visual field defects often coexist. Meningiomas involving the cavernous sinus may start in the sinus or grow into it as an extension from a larger tumour involving the medial sphenoid wing, orbit, clivus, or petrous bones. Natural history in some patients may be that of minimal or no growth for long periods of time; given the risk of significant cranial nerve morbidity with surgical treatment, management decisions are difficult.