As per Jefferson classification, she would come under the unclassifiable category while as per the Ishikawa classification; the lady could be classified as a posterior cavernous sinus syndrome == DISCUSSION == Ishikawa was the first author who analyzed CS structure by stereotaxically analyzing 30 m serial CS areas. of patients could be classified using Jefferson classification, 95. 5% of patients could be classified using Ishikawa plan. CSS was classified because anterior, middle, and posterior in 17. 8%, 21. 9%, and 8. 2% of patients, respectively, as per the Jefferson classification. As per the Ishikawa classification, 37% of patients each showed anterior and posterior CSS, 16. 4% showed middle CSS, whereas 4. 1% had whole CSS. Middle CSS was significantly associated with the presence of fungal infections (P= 0. 045) as per Jefferson classifications, and anterior CSS was significantly associated with a vascular etiology (P= 0. 005) as per Ishikawa classification. Overall, inflammatory causes were the most common cause for anterior CSS, while tumors accounted for maximum cases of posterior CSS. == Conclusion: == Although more number of patients could be classified using Ishikawa classification, there was no advantage of Ishikawa classification over Jefferson with regard to dedication of etiology of CSS. KEYWORDS: Cavernous sinus syndrome, Ishikawa, Jefferson == INTRO == The term cavernous sinus syndrome (CSS) is used to denote any disease process which affects the CS.[1, 2, three or more, 4] Determination of exact etiology of CSS is often difficult due to the lack of amenability to cells diagnosis. Thus, treatment is often empirical and based on clinical presentation and radiological findings. Thus, if the classification of CSS into different types can throw light on underlying etiology, it might help in further management. CSS was first classified by Jefferson[5] into three types based on the extent of involvement of trigeminal nerve [Table 1]. Since then, this classification has been the gold standard and given in most textbooks of neurology. In 1996, Ishikawa[6] emphasized the lack of clinico-anatomical correlation in Jefferson’s classification and proposed a new classification of CSS [Table 1].[7] Consequently, a Japanese study discovered that majority of patients who also remained unclassified by Jefferson classification can U-69593 be classified using Ishikawa plan. Furthermore, when classified in accordance to Ishikawa’s scheme, anterior CS lesions were often due to inflammatory etiologies, whereas middle and posterior CS lesions were due to malignancies, suggesting that this classification system may play a role in determining etiology of CSS.[7] However , etiological profile of CSS is likely to be diverse in developing countries (e. g., India) where infections constitute a major chunk. There is no data regarding the utility of those two classification schemes from developing world. Thus, we planned this study to compare power of these two systems of classification in CSS. == Table 1 . == Jefferson’s and Ishikawa classification of cavernous sinus lesions == Aims and objectives == To compare the power of Jefferson versus Ishikawa classification in the evaluation of CSS. == Patients andMethods == U-69593 This prospective observational study was conducted from January 2014 to July 2015, on 73 patients of CSS at a Tertiary Treatment Hospital and University Teaching Center in Northern India. The study was approved by the Institutional Ethics Committee and written knowledgeable consent was obtained from all the patients. CSS was defined as involvement of 2 or more from the third, fourth, fifth (V1, V2), or sixth cranial nerves, or involvement of only 1 of them in combination with a neuroimaging-confirmed lesion in the CS. Once enrolled, all the patients were subjected to meticulous history and detailed examination. All the patients underwent investigations including comprehensive hemogram with erythrocyte sedimentation U-69593 rate and C-reactive protein, biochemistry profile, serum electrolytes, testing to get human immunodeficiency virus as well as hepatitis W and C viruses, Gadolinium-enhanced magnetic resonance imaging brain on a 1 . 5 Tesla Magnetom with thin section cuts from the CS region. Further etiological work-up including biopsies, antinuclear, and cytoplasmic anti-neutrophilic antibody testing, serum galactomannan, serum angiotensin converting enzyme levels, contrast-enhanced computed tomography check out of chest and stomach and cerebrospinal fluid examination, was carried out wherever indicated. All the patients were classified using Jefferson and Ishikawa schemes by two neurologists with experience in neuro-ophthalmology independently, and final decision was taken by Spi1 consensus. == Statistical analysis == Statistical analysis was performed using SPSS edition 22 (IBM Corp. Released 2013. IBM Statistics to get windows, Edition 22. 0. Armonk, NY:.