061  A retrospective cohort study of cavernous sinus/orbital apex syndromes presenting to Imperial College London. Issue 6 (27th May 2022)

• Record Type: Journal Article
• Authors: Baheerathan, Aravindhan; Huang, Yun; Dixon, Luke; Everitt, Alex
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 6(2022)
• Page Start: A119
• Page End: A119
• Publication Date: 2022-05-27
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-ABN.386
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Introduction: The differential diagnosis of patients presenting with cavernous sinus (CSS) or orbital apex syndromes (OAS) are broad and can be challenging with regards to both diagnosis and treatment. Methods: We performed a retrospective cohort study of such presentations at our institution from 2015–2021, collecting demographics, investigations and their yield, final diagnosis and management & outcomes. Results: 30 patients Mean age 50 ± 18.3 years Prominent pain in 87% Raised ESR in 27% which subsequently normalised IgG4 subsets raised in 7% Matched oligoclonal bands and raised CSF protein were the commonest CSF anomalies All had cross-sectional imaging 2 patients with an initially normal MRI had a repeat diagnostic MRI within 2 weeks 30% of patients had either lymph node or retro-orbital tissue biopsy 76% had idiopathic retro-orbital inflammation, 7% neurosarcoidosis and 7% IgG4 disease 10% had a neoplastic process Good recovery seen for idiopathic retro-orbital inflammation treated with IVMP and steroid taper Conclusion: A high number of patients in our cohort with CSS/OAS have a presumed inflammatory aetiology but with excellent clinical outcome. When clinical suspicion remains high, patients should have interval MR imaging. Bloods & lumbar puncture generally demonstrate non-specific abnormalities and a tissue diagnosis should be obtained if possible for diagnostic security. [e-mail]