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The role of anticoagulation in cavernous sinus thrombosis

From the Department of Neurology, University of Michigan Medical Center, Ann Arbor, MI.

Prior to the antibiotic (AB) era, cavernous sinus thrombosis (CST) was almost uniformly fatal. AB therapy has significantly reduced mortality, but additional treatment with anticoagulants (AC) has remained controversial. We reviewed our experience with seven cases, as well as the literature since Lyons' 1941 introduction of AC treatment, to determine effectiveness, complications, and morbidity among survivors. We divided the cases into (1) those treated with AB alone, and (2) those treated with a combination of AB and AC. We found no conclusive evidence for reduction of mortality when AC was used in combination with AB. However, early AC therapy reduced morbidity (blindness, stroke, ophthalmoplegia, hypopituitarism, focal seizures, and vascular steal syndrome), whereas delayed or inadequate use provided no apparent benefit above AB therapy alone. Complications of AC therapy were rare; cerebral venous thrombosis occurred frequently, but in association with dural sinus thrombosis as a direct result of the disease. We conclude that AC therapy is indicated early in the treatment of CST to reduce morbidity among survivors.

Address correspondence and reprint requests to Dr. Levine, Center for Cerebrovascular Disease Research, Department of Neurology, K-l 1, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202.

Dr. Levine is a Research Fellow of the American Heart Association of Michigan.

Presented in part at the thirty-seventh annual meeting of the American Academy of Neurology, Dallas, TX, April 1985.

Received May 27, 1987. Accepted for publication in final form August 7, 1987.

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