Septic Cerebral Vein Thrombosis and Abnormal Leptomeningitis as a Complication From a Periodontitis in a Hispanic Male: Case Report and Literature Review

Abstract

Sinus vein thrombosis is a rare form of stroke that results from thrombosis of the dural vein sinus. Despite the variety of diagnostic procedures and treatment, septic thrombosis of the cavernous sinus can cause significant morbidity and mortality if not diagnosed and treated as an emergency. The clinical presentation of proptosis that occurs suddenly accompanied by erythema of the eyelid and limitation of ocular movement should alert the clinician of the possibility of cavernous sinus thrombosis. A 38-year old Hispanic male presented with pounding headache, mainly in the occipital region that began 1 week prior to hospital admission. During the hospitalization the patient subsequently developed a progressive worsening of proptosis, lacrimation and neck pain. The MRI and venography of the brain showed a cerebral venous thrombosis (CVT) with a reactive diffuse leptomeningitis. The underlying cause was a chronic dental infection. The patient was treated with course of antibiotics and discharged. A few weeks later the repeated imaging studies showed a resolution of the CVT and leptomeningitis. Although rare, septic vein thrombosis (SVT) remains a potentially lethal complication of infections that involve the sinuses, face, ears and oral cavity. The early recognition and differentiation from other diseases are keys to reducing mortality rates and long-term sequelae. Advances in imaging, especially CT and MRI have contributed substantially to the rapid diagnosis of the condition. J Med Cases. 2013;4(9):598-601 doi: http://dx.doi.org/10.4021/jmc1370w