Background Cavernous sinus syndrome is caused by numerous diseases including vascular, infective, infiltrative, inflammatory, traumatic and thrombotic.

Objective To determine the common presentation symptoms and signs, time period it takes to present and diagnose and the prevalence of the principal causes.

Method A 9-year retrospective review (2002–2011) was performed on patients diagnosed with this syndrome at the Department of Neurology, Royal Preston Hospital, Lancashire Teaching Hospital.

Results A total of 36 patients were identified (Age: 22–84 years). On average, first symptom to presentation was 12.6 months (Median 2.0). The commonest symptoms of presentation in sequential order were pain, double vision, visual impairment and ptosis. The commonest cranial nerves involved in chronological order were III, VI, V1, II, IV and V2. The average time from presentation to diagnosis was 1.3 months (Median 0.9). The cause was identified in 31 cases, with more than 50% being neoplastic, 29% inflammatory, 13% vascular and 6.5% infection. Six patients died and one patient is under palliative care.

Conclusion Cavernous sinus syndrome is a serious disease with high morbidity and mortality. We describe a strikingly high prevalence of neoplasia in patients with cavernous sinus syndrome.