Original Research
HIV-associated cavernous sinus disease
Submitted: 25 April 2018 | Published: 20 March 2019
About the author(s)
Cait-lynn D. Wells, Department of Neurology, Greys Hospital, University of KwaZulu-Natal, Pietermaritzburg, South AfricaAnand A. Moodley, Department of Neurology, Universitas Hospital, University of the Free State, Bloemfontein, South Africa
Abstract
Introduction: The underlying diagnosis of cavernous sinus disease is difficult to confirm in HIV-coinfected patients owing to the lack of histological confirmation. In this retrospective case series, we highlight the challenges in confirming the diagnosis and managing these patients.
Results: The clinical, laboratory and radiological data of 23 HIV-infected patients with cavernous sinus disease were analysed. The mean age of patients was 38 years. The mean CD4+ count was 390 cells/μL. Clinically, patients presented with unilateral disease (65%), headache (48%), diplopia (30%) and blurred vision (30%). Third (65%) and sixth (57%) nerve palsies in isolation and combination (39%) were most common. Isolated fourth nerve palsy did not occur. Tuberculosis (17%) was the most commonly identified disorder followed by high-grade B-cell lymphoma (13%), meningioma (13%), metastatic carcinoma (13%) and neurosyphilis (7%). In 22% of the patients, there was no confirmatory evidence for a diagnosis. The patients were either treated empirically for tuberculosis or improved spontaneously when antiretroviral therapy was started. Cerebrospinal fluid was helpful in 4/13 (31%) of patients where it was not contraindicated. Only 3/23 (13%) of the patients had a biopsy of the cavernous sinus mass. The outcomes varied, and follow-up was lacking in the majority of patients.
Conclusion: In HIV-infected patients, histological confirmation of cavernous sinus pathology is not readily available for various reasons. In resource-limited settings, one should first actively search for extracranial evidence of tuberculosis, lymphoma, syphilis and primary malignancy and manage appropriately. Only if such evidence is lacking should a referral for biopsy be considered.
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Crossref Citations
1. Neuro-Ophthalmic Manifestations of HIV Infection
Lynn K. Gordon, Helen Danesh-Meyer
Ocular Immunology and Inflammation vol: 28 issue: 7 first page: 1085 year: 2020
doi: 10.1080/09273948.2019.1704024