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( Cavernous Sinus Syndrome )

‫ ﻟﺬاﻟﻚ ﻻزم‬، ‫ ﻳﺴﺒﺒﻪ أﻛﺜﺮ ﻣﻦ ﻣﺮض‬presentation ‫ﻋﺒﺎرة ﻋﻦ‬

. ‫ﺗﻌﺮف اﻟﺴﺒﺐ‬

. Cavernous Sinus ‫ﻳﻀﺮب ﻛﻞ ﺷﻲء ﻳﻌﺪي ﻓﻲ اﻟـ‬

- CN3 & CN4 & CN6

‫ ﻷﻧﻪ ﻳﻀﻐﻂ ﻋﲆ اﻟـ‬Loss Corneal Sensation ‫ﻳﻌﻤﻞ‬

Maxilary ‫ واﻟـ‬Opthalmic

. horner syndrome ‫ وﻳﺴﺒﺐ‬ICA ‫ﻳﻀﻐﻂ ﻋﲆ اﻟـ‬

. ‫ﻣﺶ ﻻزم ﻛﻞ اﻷﻋﺮاض ﺗﺤﺼﻞ‬

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. ‫ ﻟﻮ اﻟﺴﺒﺐ ﻏﻴﺮ ﻣﻌﺮوف‬Tolosa-Hunt S ‫اﻟـ‬

$ Clinical Presentation :
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. ‫ﻓﻴﻪ أﻋﺮاض ﻣﻌﻴﻨﺔ ﻟﻮ ﺟﺎت ﻻزم ﺗﻔﻜﺮ ﺑﺴﺒﺐ ﺧﻄﻴﺮ‬

‫ ﻣﻤﻜﻦ ﺗﻜﻮن‬Rigors ‫ واﻟـ‬Tachycardia ‫ و‬Fever ‫اﻟـ‬

. cavernous Sinus thrombosis

‫ ؟‬Cavernous Sinus Syndrome ‫ﻛﻴﻒ ﻧﺸﺨﺺ‬

‫ﺗﺤﺼﻞ ﻓﻲ ﻧﻔﺲ اﻟﻌﻴﻦ‬

6th Nerve Palsy + Horner Syndrome
cavernous sinus ‫ﻷن ﻫﺬوﻻ اﻹﺛﻨﻴﻦ ﻣﺎ ﻳﻠﺘﻘﻮن أﺑﺪاً اﻻ ﻓﻲ اﻟـ‬
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. Parkinson Sign ‫وﻧﺴﻤﻴﻬﺎ‬

‫ وﻫﻮ ﻋﺒﺎرة ﻋﻦ‬Orbital Apex Syndrom ‫ﻓﻲ ﻣﺮض ﻧﺴﻴﻤﻪ‬

Optic Nerve ‫ و ﻣﻌﻪ‬Cavernous Sinus Syndrome
. dysfunction

( Mucormycosis )
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‫ﻟﻴﺲ ﻧﻮع واﺣﺪ وﻟﻜﻦ ﻋﺎﺋﻠﺔ ﻣﻦ اﻟـ ‪ Molds‬ﺗﺴﻤﻰ‬

‫‪. Mucormycetes‬‬

‫ﻳﺼﻴﺐ ﺿﻌﻴﻒ اﻟﻤﻨﺎﻋﺔ واﻟﻠﻲ ﻋﻨﺪﻫﻢ ‪ Acidosis‬ﻷﻧﻪ ﻳﺄﺧﺮ‬

‫‪ Aggregation‬ﻟﻠـ ‪ Granulocytes‬واﻟـ ‪ Fibroblast‬ﻓﻤﺎ ﻳﺘﻢ‬
‫ﺣﺼﺎر اﻟـ ‪. Infection‬‬

‫اﻟﻤﺸﻜﻠﺔ ﻓﻴﻪ أﻧﻬﺎ ‪ ، rapidly progressive‬ﺗﺪﺧﻞ ﻟﻠـ ‪Blood‬‬

‫‪ Vessels‬ﻓﺘﻌﻤﻞ ‪ Ischemia‬و ‪ Necrosis‬و ‪ Infarction‬ﻟـ‬
‫‪ Tissue‬اﻟﻠﻲ ﻳﻐﺬﻳﻪ ‪ ،‬وﻟﻤﺎ ﻳﻤﻮت اﻟـ ‪ Tissue‬ﻳﺴﺘﻌﻤﺮه اﻟﻔﻄﺮ‬
‫وﻳﺘﻐﺬئ ﻋﻠﻴﻪ وﺗﻨﺘﻘﻞ ﻟـ ‪ Blood vessels‬آﺧﺮ ‪ ،‬ﻟﺬاﻟﻚ ﺗﻨﺘﺸﺮ‬
‫ﺑﺴﺮﻋﺔ ‪.‬‬
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‫ﻳﺴﺒﺐ ﺳﻮاد ﻓﻲ اﻟـ ‪ Tissue‬ﻧﺴﻤﻴﻪ ‪Black Eschar‬‬

‫اﻟﻔﻄﺮ ﻫﺬا ﻣﻮﺟﻮد ﺣﻮاﻟﻴﻨﺎ ﺑﺸﻜﻞ ﻳﻮﻣﻲ ‪.‬‬

‫أﺷﻬﺮ ﻃﺮﻳﻘﺔ ﻳﻬﺎﺟﻤﻨﺎ ﻋﻦ ﻃﺮﻳﻖ ‪ , Inhalation‬ﺗﻨﺘﻘﻞ ﻣﻦ اﻟـ‬

‫‪ Nasal sinus‬وﺑﻌﺪﻳﻦ ﻟﻠـ ‪ Orbit‬وﺑﻌﺪﻳﻦ ﻟﻠـ ‪ , Brain‬وﻣﻤﻜﻦ‬
‫ﻳﻌﺪي ﻣﺒﺎﺷﺮة ﻣﻦ اﻟـ ‪ Nasal‬ﻟﻠـ ‪. Brain‬‬

‫وﻣﻤﻦ ﻳﺮوح ﻟﻠـ ‪ Lung‬أو ﻋﻦ ﻃﺮﻳﻖ ‪ Oral Cavity‬وﻳﺮوح ﻟﻠـ‬

‫‪. GIT‬‬

‫أﻏﻠﺐ اﻟﺤﺎﻻت ﻳﻜﻮن ﻋﻦ ﻃﺮﻳﻖ اﻟـ ‪ Ethmoid‬أو اﻟـ ‪Maxillary‬‬

‫وﻳﻮﺻﻞ ﻟﻠـ ‪. Orbit‬‬

‫ﻟﻜﻦ أﺣﻴﺎﻧًﺎ ﻳﺠﻲ ﻋﺒﺮ اﻟـ ‪ NasoLacrimal Duct‬ﺑﺸﻜﻞ‬

‫‪ Retrograde‬ﻣﻦ اﻟـ ‪ inferior Meatus‬وﻣﻦ اﻟـ ‪Lacrimal‬‬
‫‪ Sac‬ﻳﻘﺘﺤﻢ اﻟـ ‪. Orbit‬‬

‫ﻣﺸﻜﻠﺘﻪ أول ﻣﺎ ﻳﻮﺻﻞ اﻟـ ‪ Orbit‬ﻳﺮوح ﻟﻠـ ‪ Apex‬ﻓﻴﺴﺒﺐ اﻟـ‬

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Orbital Apex Syndrom ‫ واﻟـ‬Cavernous Sinus

Syndrome ‫ واﻟـ‬Horner Syndrom ‫ واﻟـ‬Optic Nerve
dysfunction ‫ و اﻟـ‬Sensory Loss ‫ ﻓﻲ اﻟـ‬V1 ‫ و اﻟـ‬V2 ، ‫و‬
Proptosis ‫ و‬Chemosis .

$ Treatment :

‫ و‬IV Amphotericin ‫ ﻋﺒﻲ اﻟﻤﺮﻳﺾ ﺑـ‬، ً‫ﺑﻤﺎ أﻧﻪ ﻋﻨﻴﻒ ﺟﺪا‬

‫ ﺑﺸﻜﻞ‬Infarction ‫ ﺻﺎر ﻓﻴﻪ‬Tissue ‫ وﺷﻴﻞ أي‬Retrobulbar
. ‫ﻳﻮﻣﻲ‬
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‫ﻓﻴﻪ ﻧﻮﻋﻴﻦ ﻣﻦ اﻟـ ‪ ، Amphotericin‬ﻳﺴﻤﻰ ‪ Liposomal‬آﻣﻦ‬

‫وﻗﻠﻴﻞ اﻟﻤﻀﺎﻋﻔﺎت و ﻓﻌﺎﻟﻴﺘﻪ أﻋﲆ وﻟﻜﻨﻪ ﻏﺎﻟﻲ ‪.‬‬

‫اﻟﺜﺎﻧﻲ ﻫﻮ ‪ Non Liposomal‬رﺧﻴﺺ وﻟﻜﻦ ﻳﻌﻤﻞ ‪Renal‬‬

‫‪ dysfunction‬وﻓﻌﺎﻟﻴﺘﻪ أﺿﻌﻒ ‪ ،‬ﻟﺬاﻟﻚ ﻣﺎ ﺗﻘﺪر ﺗﻌﻄﻲ ﻛﻤﻴﺎت‬
‫ﻛﺒﻴﺮة ‪.‬‬

‫ﻟﻮ ﺣﺼﻞ ‪ Damage‬ﻟﻠـ ‪ Optic Nerve‬ﺗﻌﻤﻞ ‪Exentration‬‬

‫ﻋﺸﺎن ﺗﺤﻤﻲ اﻟـ ‪. Brain‬‬