674 Case Report: The Spectrum of Outcome From Cavernous Sinus Thrombosis

Abstract

Cavernous sinus thrombosis is a rare but serious complication of infections in the face and throat. We present two case reports demonstrating the spectrum of outcome in children. Case 1: An 11 year-old boy presented with a fourday history of frontal headache and pain in his right eye At presentation he was alert, had right ptosis and bilateral orbital cellulitis An urgent CT head did not reveal any brain or meningeal involvement, but MRI demonstrated frontal sinus empyema with bilateral cavernous sinus thrombosis The causative organism isolated was sensitive Smilleri He improved well following 10 days of antibiotics and prophylactic anticoagulation was commenced A repeat MRI 8 days later showed cavernous sinuses within normal limits. Case 2: A two and a half year-old boy presented with a five-day history of being unwell and a 24-hour history of altered conscious level On arrival, he had a GCS of 11, left eye cellulitis and a third nerve palsy. An urgent CT head revealed a retropharyngeal abscess, thrombosis of left internal jugular vein and bilateral cavernous sinus thrombosis The retropharyngeal abscess was drained surgically and broad-spectrum antibiotics and anticoagulation were instituted The causative organism isolated was H influenza Within 36 hours, there was bilateral internal carotid artery thrombosis leading to global hypoxic ischaemic encephalopathy confirmed on EEG and MRI The child died a few days later on a palliative care pathway. Conclusion: CST carries a reported mortality of 40% We conclude that despite prompt treatment the range of outcome is still extensive.