Cavernous sinus lesions

Munawar, Khalid; Nayak, Gopi K.; Fatterpekar, Girish M.; Sen, Chandranath; Zagzag, David; Zan, Elçin; Hagiwara, Mari

doi:10.1016/j.clinimag.2020.06.029

Cited by 44 publications

(35 citation statements)

References 41 publications

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“…Pituitary adenomas may encase the ICA but generally do not narrow the artery. 25 Meningiomas encasing the cavernous ICA often narrow the lumen of the vessel but do not show reversal after steroid therapy and may have characteristic features, such as broad dural base and dural tail. 11 Lymphomas generally cause enlargement of the CS without compressing the ICA and may also show evidence of extension through skull base foramina.…”

Section: R Esultsmentioning

confidence: 99%

“… 11 Lymphomas generally cause enlargement of the CS without compressing the ICA and may also show evidence of extension through skull base foramina. 25 Normalization of the ICA caliber after steroids indicates an inflammatory component in the causative lesion. Sarcoidosis of the CS does not have distinguishing features, and diagnosis depends on additional signs such as adjacent dural thickening, pachymeningeal or leptomeningeal enhancement, thickened CN, and evidence of pituitary or orbital involvement.…”

Section: R Esultsmentioning

confidence: 99%

“…Evidence of pulmonary and/or other systemic involvement aids in cinching the diagnosis. 25 Granulomatosis with polyangiitis-related CS lesions show markedly low-signal intensity on T2-weighted imaging due to internal fibrous tissue and variable enhancement. Involvement of the paranasal sinuses and orbit is typically present in association.…”

Section: R Esultsmentioning

confidence: 99%

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Tolosa–Hunt Syndrome

Dutta

Anand

2021

Journal of Current Ophthalmology

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Purpose: To review the diagnostic criteria for Tolosa–Hunt syndrome (THS) and utility of recent modifications. Methods: We searched PubMed for keywords Tolosa Hunt and magnetic resonance imaging. We compared the three editions of International Classification of Headache Disorders and isolated case reports and case series with the assessment of cavernous internal carotid artery (ICA) caliber to find the prevalence of vascular anomalies. We also evaluated cases of THS with the involvement of extracavernous structures and the possible role of idiopathic hypertrophic pachymeningitis (HP). Cases diagnosed falsely as THS were also reviewed for the presence of atypical features and relevance of criterion D. We assessed nonconforming cases (those with normal neuroimaging benign THS) and idiopathic inflammatory orbital pseudotumor (IIPO). Results: Vascular abnormalities were found in 36.36% of THS cases. Benign THS may also show changes in ICA caliber. Evidence suggestive of idiopathic HP could be found in 57% of cases with the involvement of extracavernous structures, such as facial nerve and pituitary gland. Both THS and IIPO are steroid-responsive pathologies with similar clinical and radiological features. False-positive diagnosis of THS results from early labeling, based solely on clinical features and symptom resolution after steroid therapy. Conclusions: Benign THS may be a result of limitation of resolution of available neuroimaging technique or early testing. Early and late vascular changes can be seen in both THS and its benign variant; some of them are not innocuous. THS may be considered a type of focal idiopathic HP. IIPO may represent an anterior variant of THS. In the absence of histopathological diagnosis, steroid-induced resolution of symptoms should be confirmed radiologically and followed-up.

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Section: R Esultsmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

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Tolosa–Hunt Syndrome

Dutta

Anand

2021

Journal of Current Ophthalmology

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“…The cavernous (C4) segment of the internal carotid artery is located in the medial aspect of each CS and is enwrapped by a periarterial sympathetic plexus. The oculomotor nerve (cranial nerve [CN] III), trochlear nerve (CN IV), and ophthalmic and maxillary branches of the trigeminal nerve (CN V1 and CN V2, respectively) pass through the lateral dural wall of each CS from top to bottom; on the other hand, the abducens nerve (CN VI) is located below and lateral to the internal carotid artery directly within the CS 4 . The CS collects blood from the superior and inferior ophthalmic veins, sphenoid sinus, and superficial cortical vein and drains into the superior and inferior petrosal sinuses and pterygoid venous plexus 5 .…”

Section: Discussionmentioning

confidence: 99%

“…The CS is susceptible to neoplastic, vascular, and inflammatory pathological diseases 4 . Imaging plays an essential role in narrowing the neoplastic pathology‐related differential diagnoses, including pituitary adenoma, schwannoma, meningioma, lymphoma, direct tumor invasion, and metastasis.…”

Section: Discussionmentioning

confidence: 99%