Clinical and Investigational Profile of Patients with Cavernous Sinus Syndrome in a Tertiary Care Hospital Setup in North India

Objective :To study the clinical, investigational profile and therapeutic outcome of patients with cavernous sinus syndrome (CSS) and identify factors which could determine the etiologies and influence the outcome of these patients.Background :Cavernous sinus syndrome is a common cause of painful opthalmoplegia. These patients have diverse etiologies ,presentations and outcomes and often pose a diagnostic dilemma as they are not easily amenable for biopsy. There is a paucity of Indian data of patients with CSS.Methods :In this prospective observational study we included 73 consecutive patients satisfying the criteria of cavernous sinus syndrome ie involving any 2 of the 3rd ,4th ,5th and 6th cranial nerves or any one of them with radiological cavernous sinus involvement , and these were subjected to a battery of haematological , biochemical and radiological investigations based on the etiological suspicion, diagnosed and treated as per guidelines.Results :We could give a definitive etiological diagnosis in 86[percnt] of the patients. Tumours followed by fungal infections and tolosa hunt syndrome were the commonest causes of CSS. Diabetes , severe vision loss, clinical absence of bilateral disease and presence of nasal discharge showed a significant association with a fungal etiology. On contrast enhanced MRI imaging of the brain and cavernous sinus , paranasal sinusitis ,bone erosion and ICA involvement were independently and in combination significantly associated with a fungal etiology (p=0.0001) whereas orbital apex involvement had a significant negative association with a neoplastic etiology (p=0.014).MRI was the preffered imaging modality over CT scan (p=0.0001). Over a 6 months follow up ,65.2[percnt] overall patients and 70[percnt] patients with a fungal etiology had a good prognosis.Conclusion : A definitive diagnosis and a good prognosis was possible in these patients if managed early and appropriately.Study supported by : Nil Disclosure: Dr. bhatkar has nothing to disclose. Dr. Goyal has nothing to disclose. Dr. Mukherjee has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Lal has nothing to disclose.