Case Of Cavernous Sinus Thrombosis Research Articles

Bilateral Cavernous Sinus Thrombosis (CST) During the Early Pregnancy

Cavernous Sinus Thrombosis (CST) is a rare but serious condition with long term morbidity and mortality. Pregnancy and nausea vomiting during pregnancy are well known risk factors. Early identification and prompt interventions will minimize the complications of CST. This is a case of CST which presented in first trimester of the pregnancy.

Тромбоз кавернозного синуса при инфекции COVID-19

Cavernous sinus thrombosis is a rare and life-threatening disease. The etiology of the disease is different: bacterial, viral, parasitic, traumatic, etc. During the period of widespread COVID-19, the possibility of cavernous sinus thrombosis developing is also affected by respiratory and renal failure, blood clotting disorders caused by coronavirus. The article presents a case of cavernous sinus thrombosis that developed in a patient who had coronavirus infection with damage to the respiratory system. As the result of treatment, the process was arrested, general condition of the patient has fully recovered. Key words: Cavernous sinus thrombosis; infection; СОVID-19.

Клинический случай тромбоза кавернозного синуса у молодой пациентки после перенесенного COVID-19

The article presents a clinical case of cavernous sinus thrombosis after suffering COVID-19 with complaints of decreased visual acuity and signs of papilledema Hypercoagulability associated with COVID-19 is caused by an active immune response to infection and may predispose to the development of a thromboembolic event in the cavernous sinus. Thus, close attention should be paid to patients' complaints of visual impairment caused by coronavirus infection. Clinical manifestations of cavernous sinus thrombosis may appear some time after the infection due to the possible long-term circulation of this virus in the body, activating immune complexes that cause cavernous sinus thrombosis, followed by the manifestation of ophthalmic symptoms. Keywords: cavernous sinus thrombosis, COVID-19, optic neuropathy, papilledema

Pediatric COVID-19–Associated Cavernous Sinus Thrombosis

This report details the physical and imaging findings associated with a pediatric case of cavernous sinus thrombosis (CST) that developed in the setting of COVID-19 infection, sinusitis, and orbital cellulitis. COVID-19 is rarely associated with CST but may contribute to the development by inducing hypercoagulability.

Gradenigo’s syndrome as a rare complication of acute otitis media in a child – case study

Gradenigo’s syndrome (GS) is a rare complication of otitis media and is defined as a concomitant unilateral acute inflammation of the middle ear, facial pain in the region supplied by the trigeminal nerve and abducens nerve palsy. It occurs in less than 2 in 100 thousand cases of acute otitis media. Cavernous sinus thrombosis (CST) is a rare complication usually accompanying sinusitis, however a few cases of CST in the course of GS were described before. We present a case of a 11-year old boy with a history of otitis media admitted to the Department of Pediatric Otolaryngology of a tertiary care center with vomiting, headache, unilateral paresthesia of the face and diplopia. Cavernous sinus thrombosis as well as inflammation of the temporal bone including the petrous apex with formation of a subperiosteal abscess was shown in CT and MRI scans. The patient was treated with ceftriaxone, metronidazole and vancomycin, as well as enoxaparin and warfarin. Antromastoidectomy of the right temporal bone was performed. The patient recovered gradually over the course of treatment with a complete resolution of CST in MRI and abducens nerve palsy after in clinical examination after 11 weeks of treatment. Even though both Gradenigo’s syndrome and cavernous sinus thrombosis are rare entities the knowledge of their clinical manifestations is very helpful for both laryngologists, pediatricians and general practitioners. Early diagnosis and prompt introduction of treatment are crucial for successful treatment and avoiding dangerous sequelae.

Тромбоз кавернозного синуса, ассоциированный с COVID-19

This paper describes a case of cavernous sinus thrombosis The condition developed in a patient who had been treated for confirmed COVID-19 Left eye examination findings were as follows: amaurosis;absence of periorbital skin sensation;signs of orbital cellulitis;ptosis;chemosis;total ophthalmoplegia;exophthalmos;decreased corneal sensation;widened pupil;and absence of pupil light reflex In addition, ophthalmoscopy showed diffused retinal and optic disc edema The patient had an atypical clinical course which could not be clearly identified as septic or aseptic, and his elevated D-dimer level could indicate a potential relationship between this condition and COVID-19 © Oripov O I , Bilalov E N , 2021

A case of invasive fungal sinusitis by candida species causing blindness

Invasive fungal sinusitis (IFS) is a common manifestation in immunocompromised patients. The common offenders are Aspergillus and Mucor. These fungal infections can cause various systemic complications, both intracranial and extracranial. Ultimately it may lead to fungemia and death. Very few cases of IFS caused by candida have been reported in the literature. Candida is a yeast like fungus, present normally as a commensal in the oral cavity and skin. Invasive fungal sinusitis with central retinal artery occlusion (CRAO) with candida is extremely rare. We are reporting a case of cavernous sinus thrombosis (CST) with CRAO causing bilateral blindness in a patient with invasive candida sinusitis.

Our Experience in the Management of Orbital Complications in Acute Rhinosinusitis

Background and objectiveThe spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60–75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. Materials and methodsWe carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. ResultsThe average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (<4 years) with a small and medial subperiosteal abscess (<4 mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. ConclusionOrbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required.

Nuestra experiencia en el manejo de las complicaciones orbitarias en la rinosinusitis aguda

Background and objectiveThe spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60-75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. Materials and methodsWe carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. ResultsThe average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (<4 years) with a small and medial subperiosteal abscess (<4mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. ConclusionOrbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required.

Bilateral cavernous sinus thrombosis as first manifestation of primary Burkitt lymphoma of the thyroid gland

Cavernous sinus thrombosis (CST) is a rare condition that is usually associated with infections, pregnancy, vasculitis and some types of medication, such as the contraceptive pill and paraneoplastic. Primary Burkitt lymphoma (PBL) of the thyroid gland is very uncommon and the clinical description of such cases has been largely limited to case reports. In this paper, we present a case of CST as the first manifestation of PBL of the thyroid gland. To the best of our knowledge, our patient is the first case report of PBL of the thyroid gland that presents with bilateral CST.

A Severe Case of Septic Cavernous Sinus Thrombosis Caused by a Rare Pathogen

SESSION TITLE: Student/Resident Case Report Poster - Critical Care IV SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Cavernous Sinus Thrombosis (CST) is thrombophlebitis in the cavernous sinuses. Before the availability of antibiotics, this dramatic and lethal illness carried a 100% mortality, therefore, the onus is on the clinician to have early recognition of this disease and treatment options, which include antibiotics, anticoagulation, and surgery. Although there have been case reports of CST as a complication of paranasal sinusitis, otitis media, and pharyngitis in pediatric population, literature review reveals few cases of CST in adults causing multi-organ impairment similar to our patient. We report a case of CST causing cranial nerve palsy and internal carotid artery narrowing from ethmoid and sphenoid sinusitis secondary to Group C, Beta Hemolytic Streptococcus. This is a common flora of upper airways and skin and bacteremia is almost always seen in immunocompromised individuals and rarely seen in an immunocompetent patient like ours. CASE PRESENTATION: 36 year old female with no significant past medical history presented to the ED with a three day history of left sided headaches, subjective fevers, diplopia and left periorbital swelling. On exam, she was febrile with left eye proptosis and left lateral gaze palsy. Labs revealed significant leukocytosis with left shift and elevated inflammatory markers. CTA head and neck showed left cavernous sinus thrombosis/thrombophlebitis as well as narrowing of left internal carotid artery with MRI/MRV confirming these findings. Imaging also revealed bilateral complete opacification of sphenoid and ethmoid cells suggestive of severe sphenoiditis and ethmoiditis. She was admitted to ICU and her course was complicated by septic shock and acute hypoxemic respiratory failure requiring pressors and mechanical ventilation as per ARDS protocol. Further septic workup revealed the patient to have beta hemolytic, group C strep bacteremia with nasal culture showing the same speciation. She was started on IV antibiotics and heparin drip in ICU and was later discharged home on oral warfarin and IV ceftriaxone. DISCUSSION: The likely mechanism in our patient is that she initially had ethmoiditis causing orbital inflammation and thrombophlebitis of the ophthalmic vein, which extended posteriorly to cause septic CST. Literature review shows that S. aureus encompasses two-thirds of the cases followed by streptococci, especially pneumococci, but there have been no cases, to our knowledge, of group C beta hemolytic strep causing CST. CONCLUSIONS: Aggressive multidisciplinary approach to management remains key in these patients due to high mortality if there is a delay in early and proper diagnosis. Sinusitis and ethmoiditis are relatively common and a physician should be aware of the potential adverse consequences, especially in the setting of ptosis, proptosis, and external opthalmoplegia. Reference #1: Hiroshi Sakaida, Masayoshi Kabayashi, Ai Ito. Cavernous Sinus Thrombosis: linking a swollen red eye and headache. Lancet 2014: 384: 928 DISCLOSURE: The following authors have nothing to disclose: Hemal Mehta, Anthony Saleh, Ravish Singhal No Product/Research Disclosure Information

咀嚼筋間隙膿瘍・細菌性髄膜炎から海綿静脈洞血栓症を呈した1例

症例は77歳の女性。左上顎犬歯の破折を契機に食事が摂れなくなり，7日後に37℃台の発熱及び歩行時のふらつきによる転倒を主訴に当院救急外来を受診。髄液細胞数の増加及び脳MRIでの咀嚼筋間隙の膿瘍形成の所見から，細菌性髄膜炎を合併した咀嚼筋間隙膿瘍と診断。抗生剤投与により炎症所見は改善したが，入院7日目に両眼球突出を伴った全方向性の眼球運動障害が出現。D-dimerの上昇，頭部造影CTでの上眼静脈の造影欠損から，海綿静脈洞血栓症と診断。抗生剤投与・膿瘍の穿刺排膿に加えて抗凝固療法を行なうことで，炎症所見及び海綿静脈洞血栓症による眼球運動障害は改善を認め，後遺症なく退院した。海綿静脈洞血栓症は，抗生剤の発達により現在では発生頻度は減少しているものの予後不良の疾患であり，早期診断・治療が重要である。

Cavernous Sinus Thrombosis in Children.

Investigators from the Children's Hospital of Philadelphia analyzed the clinical and radiographic findings in 12 cases of cavernous sinus thrombosis (CST) seen between 2000 and 2013, and conducted a literature search and review of the pooled data.

A case of cavernous sinus thrombosis complicating orbital cellulitis

A 47-year-old patient with a swelling of the left upper eyelid, redness, proptosis, and defective vision of few days duration was seen in our clinic. The history, examination, and investigations were suggestive of cavernous sinus thrombosis complicating orbital cellulitis. The patient was admitted and treated by a team of specialists including ophthalmology, neurosurgery, and hematology. Patient recovered fully after 3 weeks of treatment. This case report is being presented to highlight the importance of careful clinical examination and high index of suspicion in recognizing such a serious complication.

A Case of Cavernous Sinus Thrombosis with Proptosis Successfully Treated with Prompt Management

A Case of Cavernous Sinus Thrombosis with Proptosis Successfully Treated with Prompt Management

A case of cavernous sinus thrombosis caused by Dialister pneumosintes, Slackia exigua and Prevotella baroniae

Introduction: Cavernous sinus thrombosis (CST) is a rare manifestation of cerebral venous thrombosis. We herein describe the first case of CST associated with the oral microbes (Dialister pneumosintes, Slackia exigua and Prevotella baroniae). Case presentation: An 82‐year‐old previously self‐supported Japanese woman presented with acute onset of impaired consciousness. Computed tomography revealed intracranial haemorrhage complicated with CST. D. pneumosintes, Slackia exigua and P. baroniae were cultivated from two sets of blood cultures and were identified with 16S rRNA sequencing. The patient was successfully discharged after ampicillin–sulbactam treatment, which was performed soon after admission. Conclusion: To our knowledge, this is the first description of CST caused by D. pneumosintes, Slackia exigua and P. baroniae. CST should be considered in cases of unusual distribution of cerebral haemorrhage.

Challenging presentations of cavernous sinus thrombophlebitis

AimThe purpose of this study was to describe two challenging cases of septic cavernous sinus thrombosis (CST), which presented with vastly different clinical signs and symptoms.MethodsWe present two cases of CST with markedly differing clinical presentations, medical comorbidities, and degree of impairment. Initial imaging of each patient failed to show thromboembolic disease.ResultsBoth patients required multiple imaging procedures to arrive at the correct diagnosis. Each child did respond to treatment once the correct diagnosis was made.ConclusionCST can have a highly variable clinical presentation, from a subtle sixth nerve palsy to complete ophthalmoplegia and loss of periorbital sensation and corneal reflex. Onset of symptoms may be acute and fulminant or indolent and delayed. The diagnosis is challenging, requiring clinical suspicion and confirmation by imaging. These cases illustrate the importance of retaining clinical suspicion when cranial nerve palsies persist and how valuable rescanning a patient can be.

Chronic subdural hematoma leading to fatal cavernous sinus thrombosis

Presented is a case of cavernous sinus thrombosis in a young female with fatal outcome. There were not any septic focus, no history of head trauma, no relation with pregnancy. Computed tomography scan of brain showed chronic subdural hematoma. An attempt is made to correlate the aetiopathology with the clinical features of this rare case presentation.

Cavernous sinus thrombosis secondary to MRSA septicaemia

Purpose: To report the first case of cavernous sinus thrombosis (CST) due to methicillin-resistant Staphylococcus aureus (MRSA) infection. Also, to emphasise that MRSA infection may be acquired in the community. Method: Single observational case report. Results: CST has a very high mortality and morbidity and has been reported as a rare complication of localised and systemic infection. We present the case of a 35-year-old female intravenous (IV) drug user presenting with septicaemia and heroin overdose. Following initial resuscitation, she gained consciousness but remained confused with Glasgow Coma Scale (GCS) of 8/15. The patient was febrile and there was a marked bilateral proptosis, eyelid swelling with erythema, and conjunctival chemosis. Pupils were pinpoint. Ocular movements appeared limited. In view of the high index of suspicion of CST, the patient was intubated for an urgent CT scan of the brain and orbits, which confirmed the disorder's diagnosis. High-dose IV ceftazadime, metronidazole, and flucloxacillin was commenced. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient had not had any prior hospital contact. The source of infection was not identified, but the subsequent CT scan indicated multiple intracerebral abscesses and multiple cavitating abscesses of the lungs with a large pleural effusion. The patient died nine days after admission to hospital. Conclusion: MRSA infection can be acquired in the community and should be borne in mind by ophthalmologists when dealing with infections. To the authors' knowledge, this is the first case of CST secondary to MRSA sepsis.

Cavernous Sinus Thrombosis: Report of Case

A case of cavernous sinus thrombosis is discussed to show how the dentist must be able to diagnose possible complications secondary to dental surgical procedures and to treat or refer a patient before a life-threatening situation develops.