Cavernous Sinus Thrombophlebitis Research Articles

Diagnosis and Management of Orbital Cellulitis in a Reference Center in Senegal

The severity of orbital cellulitis is the risk of blindness and cerebro-meningeal complications that can be life-threatening. The objective of our study was to report the clinical, paraclinical, therapeutic and progressive aspects of orbital cellulitis. This was a retrospective, descriptive study over 5-year, from 1st January 2017 to December 31st 2021, in the ophthalmology department of Aristide le Dantec University Hospital. We glued 102 patients. The incidence was 32.8 cases per year. The average age was 23 years, the age group from 0 to 15 years was the most representative (49%). The most frequent reason for consultation was eyelid swelling (87%). There was a predominance of preseptal cellulitis (64%). An ORL etiology was found in 21.5% of cases. Orbital-cerebral CT was performed in 57 patients. It made this possible to classify cellulite and identify sinusitis in 21.6% of cases. All patients received antibiotics and corticosteroid therapy were combined 48 hours after the start of treatment in 41 patients. The evolution was favorable in 73.5% of cases. Ten patients (9.8%) presented a complication. We aim for 3 cases of blindness. Death occurred in a patient who presented a bilateral orbital cellulitis complicated by cavernous sinus thrombophlebitis. The prognosis depends on the delay in treatment, the stage of the disease and the existence of comorbidity factors.

Cavernous Sinus Thrombophlebitis Presenting as Cluster-like Headache

Cavernous Sinus Thrombophlebitis Presenting as Cluster-like Headache

Preseptal Cellulitis Versus Orbital Cellulitis: A Pediatric Case.

Eye infection with or without swelling is a common complaint in pediatric patients. It commonly affects the eyelid, which can be confused with an insect bite, orbital pseudotumor, or panophthalmitis. The article highlights the differences between preseptal and orbital cellulitis. Preseptal and orbital cellulitis originate from other infections because of the thin bone barrier that separates the eye from other facial structures. The clinical manifestations of preseptal and orbital cellulitis may be perplexing, and emergency nurse practitioners must distinguish between the two infections. The incorrect diagnosis may lead to complications. The complications associated with orbital cellulitis are vision loss, brain abscess, vision loss, cavernous sinus thrombophlebitis, orbital cellulitis, subperiosteal abscess, and death. Thus, early diagnosis and treatment will prevent these complications.

Septic Cavernous Sinus Thrombosis Caused by Dental Infection

Purpose: We report a case of bilateral septic cavernous thrombosis caused by a dental infection.Case summary: A 58-year-old male was transferred to our hospital because of left-sided proptosis and eyelid swelling. The patient had fever and left temporal headache, which did not respond to oral and intravenous antibiotics. After experiencing a tooth injury while chewing hard food 3 months ago, the patient developed toothache and swelling around the tooth for which he did not take any treatment. The patient had left eyelid edema, ptosis, chemosis, and conjunctival congestion. The left eye movements were limited in all directions. Brain magnetic resonance imaging showed dilatation and thrombosis of the left superior ophthalmic vein and thrombosis of bilateral cavernous sinuses. The patient was treated with systemic antibiotics and anticoagulants. The blood culture showed growth of Parvimonas micra and Dialister Pneumosintes, which are common causes of dental infection.Conclusions: Septic thrombosis of the cavernous sinus and superior ophthalmic vein thrombophlebitis can occur due to the spread of dental infection. Prompt diagnosis and treatment are important for rapid resolution of symptoms and good prognosis.

Treatment strategy of nasal orbital complications in children

Objective:The aim of this study is to explore the treatment strategy of children's nasal orbital complications. Methods:The clinical data of 28 children with nasal orbital complications admitted to Dalian Children's Hospital from February 2018 to February 2021 were analyzed and summarized. Results:Among the 28 children, 18 were males （64.3%）, 10 females （35.7%）, 16 cases of orbital cellulitis, 10 cases of orbital subperiosteal abscess, 1 case of intraorbital abscess, and 1 case of cavernous sinus thrombophlebitis. Of the children with orbital cellulitis, 2 cases were treated with surgery, 4 cases with orbital subperiosteal abscess were treated with surgery, and the children with intraorbital abscess and cavernous sinus thrombophlebitis were treated with surgery. All the children were cured, and the clinical follow-up was more than half a year. No recurrence occurred. Conclusion:Periorbital cellulitis is the most common type of orbital complications. After conservative treatment （3-7 days）, most children can get good results. Once the visual acuity is progressively decreased, the infection becomes worse, the eyeball movement disorder and other symptoms occur at this time, surgical treatment should be actively considered, and the timing of surgery is very important for the prognosis.

Cavernous sinus thrombophlebitis caused by a dental infection: A case report

Septic cavernous sinus thrombosis (CST) is a rare, life-threatening complication of infections of any of the tissues drained by the cavernous sinus such as the mid-face, orbit and sinuses. With the introduction of antibiotics, the mortality and morbidity rates have significantly reduced although they remain high. The necessity of an early diagnosis and appropriate treatment is therefore of great importance. Clinical presentation includes proptosis, chemosis, ocular motor nerve palsy, and sensitive disorders. Imaging investigations, such as contrast enhanced computed tomography (CT) and magnetic resonance imaging (MRI) have had a significant impact on the diagnosis. This condition is rare and after literature review, we found very few case series and some cases reports. We herein share a case of cavernous sinus thrombophlebitis caused by a dental infection.

Acute Bilateral Blindness in the Setting of Sudden Onset of Bilateral Proptosis and Ophthalmoplegia: A Case Report With Literature Review.

Acute bilateral blindness has an extensive differential diagnosis that requires a careful history and physical examination to narrow down. In this article, we discuss the pathophysiology and radiographic findings of each possible diagnosis for acute bilateral blindness. Visual pathology with respect to bilateral blindness can be broadly broken down into 3 anatomic categories: media (i.e., the anterior and posterior chamber of the eye), retina, and neural visual pathway. Possible causes of rapid onset bilateral blindness include bilateral occipital infarcts, endogenous bacterial endophthalmitis, orbital cellulitis, orbital compartment syndrome, cavernous sinus thrombophlebitis, thyroid disease, and bilateral nonarteritic ischemic optic neuropathy. In this case, we present a patient with acute onset of bilateral blindness, in addition to bilateral ophthalmoplegia, proptosis, and orbital chemosis. We believe that this rare case of acute bilateral blindness is thought provoking and aids in the understanding of the differential diagnosis and underlying pathophysiology of visual loss.

Spectrum of Orbital Cellulitis on Magnetic Resonance Imaging.

IntroductionOrbital infection is an ophthalmological emergency as it can lead to blindness and intracranial spread. Imaging is needed to determine the extent of the infection, to localize an abscess, and for surgical planning. The role of magnetic resonance imaging (MRI) is well established in the evaluation of orbital pathologies, including orbital cellulitis and abscess, mainly due to its ability to evaluate early intracranial involvement. The objective of the study was to highlight the spectrum of MR imaging findings and the pattern of spread in fifteen patients with orbital cellulitis.MethodsA prospective study was conducted in a tertiary care hospital. Fifteen patients of all age groups, of either sex, presenting with clinical findings suggestive of orbital cellulitis, referred for MRI of orbits, were included in the study. Written informed consent was obtained prior to the study. Patients’ demographic data such as age and gender, associated co-morbidities, complications, and the pattern of spread of disease on MRI were recorded and evaluated. Descriptive statistics were used.ResultsOrbital/periorbital abscess was found to be the most common complication of orbital cellulitis (eight cases, 53.3%), followed by optic neuritis/perineuritis (four cases, 26.67%), intracranial involvement (four cases, 26.67%), dacryoadenitis (three cases, 20%) and cavernous sinus thrombophlebitis (three cases, 20%). Seven cases (46.67%) had right orbital involvement. Sinusitis was found to be the most common predisposing factor. Amongst the cases associated with sinusitis, the commonest inflamed paranasal sinus was found to be the ethmoid sinus (twelve cases). Amongst the fifteen cases of orbital/periorbital cellulitis, there were only two cases of isolated preseptal cellulitis (13.33%), five cases of postseptal cellulitis (33.33%) and eight cases of both preseptal and postseptal orbital cellulitis (53.33%).ConclusionMRI is the imaging modality of choice in the evaluation of orbital cellulitis because of its superior soft tissue and contrast resolution. It is vital to evaluate the extent of the orbital infection, underlying paranasal sinus involvement, as well as detect complications of orbital cellulitis, especially intracranial spread.

Orbital complication following sinusitis still a problem: Our experience and results

IntroductionThe orbital complications of sinusitis including cellulitis and abscess formation are well documented in both children and adults, but remain relatively uncommon. If left untreated, several complications such as orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications and orbital cellulitis can manifest including blindness, meningitis, and even death.Material and MethodsA prospective and observational study of patients presented with orbital complication secondary to sinusitis in our Hospitals from January 2019 to December 2019.ResultsIn our study total 60 patients, male patients (63.3%) more common than women (36.6%) with a ratio of 1.7:1. Frequency of age groups of 1-20 years are 23 patients (38.3%) and least were more than 61 years old patients 5%. CT of orbits and sinuses was conducted in all patients, and sinusitis and preseptal cellulitis / orbital abscess was evident in all these cases. Maximum cases were Maxillary Sinusitis (n=41) and least were Sphenoid Sinusitis (n=3). In each of the patients with sinus disease, generally more than 1 ocular symptom were found. Proposes is the highest manifestation of ocular symptoms (n=30) due to diseases of the par nasal sinuses. Other ocular symptoms that least common were decrease visual acuity (n=3) and relative afferent pupillary defect present (n=4). All patients received intravenous antimicrobials, 7(11.6%) with amoxicillin/clavulanate alone, 2(3.33%) with ampicillin/ sulbactam alone, gentamicin in 12 (20%), and the other 39 (65%) with multiple antimicrobials.ConclusionOrbital complications, secondary to sinusitis, in the new millennium still pose a serious threat to patient’s vision and life; it can lead to irreversible damage if not treated aggressively. Medical treatment is efficient in early stages while surgical drainage (endoscopic or external) in preseptal, sub periosteal or orbital abscess.

Oculomotor and Abducens Nerve Palsy Complicated by Cavernous Sinus Thrombophlebitis Resulting from Acute Sinusitis

Cavernous sinus thrombophlebitis is a rare complication of paranasal sinusitis. The disease can result in a fatal outcome if not treated with proper antibiotics or surgical intervention. Recently, we experienced a case, in which a 58-year-old female presented with oculomotor and abducens nerve palsy resulting from the cavernous sinus thrombophlebitis complicated by paranasal sinusitis. CT and magnetic resonance imaging with contrast enhancement showed right unilateral pansinusitis, left maxillary, ethmoid and sphenoid sinusitis and bilateral cavernous sinus thrombophlebitis. These conditions were resolved by endoscopic sinus surgery, administration of broad spectrum antibiotics and steroid. Key words: Abducens nerve ㆍ Cavernous sinus ㆍ Oculomotor nerve ㆍ Sinusitis ㆍ Thrombophlebitis

Cavernous Sinus Thrombophlebitis with secondary Vasculitis and Ischemic Stroke (P6.215)

Cavernous Sinus Thrombophlebitis with secondary Vasculitis and Ischemic Stroke (P6.215)

Evaluation of patients with orbital infections.

Orbital tissue infections are common infections of childhood that can lead to severe complications. Herein, we aimed to evaluate the etiologic factors, diagnosis, follow-up, and treatment procedures in pediatric patients with orbital infections. This study was performed retrospectively between January 2014 and December 2015 in Cerrahpasa Medical Faculty Pediatric Infectious Disease Unit. Patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities, and the response to these treatments. Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptal cellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever. All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis. Most orbital tissue infections occur secondary to paranasal sinusitis in childhood. Orbital tissue infections can be complicated by brain abscess, cavernous sinus thrombophlebitis, and vision loss. Early diagnosis and proper antibiotic treatment are essential to prevent these life-threatening complications.

면역억제자에서 발생한 메치실린 내성 황색포도상구균에 의한 비첨 농양

Nasal abscesses are uncommon and most frequently develops in the nasal septal space. Nasal tip abscess is rarely encountered and there have been no well-documented reports of it. Nasal abscesses occur most commonly after minor nasal trauma. As a result of nasal abscess, lethal complications such as cavernous sinus thrombophlebitis, meningitis, intracranial abscess, and sepsis may occur. We experienced a rare case of nasal tip abscess caused by Methicillin Resistant Staphylococcus Aureus (MRSA) in a immunocompromised patient with history of long-term use of corticosteroids. Therefore, we present this case with a brief review of the literature. (J Clinical Otolaryngol 2016;27:344-348)

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children.

The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. Retrospective cross-sectional study. The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS.

Bilateral Cavernous Sinus Thrombophlebitis Caused by MRSA – A Rare Clinical Entity

Bilateral Cavernous Sinus Thrombophlebitis Caused by MRSA – A Rare Clinical Entity

Fulminant Superior Ophthalmic Vein and Cavernous Sinus Thrombophlebitis with Intracranial Extensions: Case Reports

Cavernous sinus thrombophlebitis (CST) is a rare but potentially lethal condition associated with significant morbidity and mortality. The mortality and morbidity associated with CST has remarkably decreased after improvement in antibiotic treatment, but it is still a lethal disease without prompt assessment and treatment. The presence of extensive valveless communication among veins of the orbit, face, and neck, render the cavernous sinuses (CSs) vulnerable to infection. The most common primary trigger of CST is paranasal sinusitis, whereas odontogenic or otogenic infections are the less common causes (1). Bidirectional and bilateral spread of a CS infection is usual (2), and this may extend into nearby structures. We report two cases of fulminant superior ophthalmic vein (SOV) and CS infections showing intracranial extension.

Diagnosis and treatment of cavernous sinus syndrome caused by fungal infection to sphenoid sinus

To discuss the clinical diagnosis and treatment of cavernous sinus syndrome caused by fungal infection of sphenoid sinus. The clinical manifestations, imaging examination, operation methods and complications were analyzed retrospectively in 9 patients with fungal infection of sphenoid sinus treated between January 2007 and September 2012, and the clinical experience was summarized. The treatment methods included endoscopic operation combined with antifungal drugs, and the primary disease was treated actively at the same time. After treatment, one patient with cavernous sinus thrombophlebitis had complications of ptosis, eyeball fixation and could only see the moving finger in the serious eye, while the contralateral eye regained normal vision. One patient with hypoproteinemia mucormycosis and diabetic remained blindness, eyeball fixation and ptosis in the left eye. In 3 patients, the vision was improved, but the eyeball movement was still limited. In another 3 patients, there was no significant recovery of vision, with one eye fixed in movement. The symptoms in 1 patient disappeared completely. All patients had no other systemic complications. Cavernous sinus syndrome caused by the fungal infection of sphenoid sinus is rare. It is commonly happened in patients with systemic disease or immunocompromised patients. Early detection and parallel operation and continuous antifungal therapy can reduce the damage, but the prognosis is poor.

A Case of Cavernous Sinus Thrombophlebitis and Meningitis as a Complication in Osteopetrosis

Osteopetrosis is a rare genetic bone disease characterized by increased bone density but prone to breakage due to defective osteoclastic function. Among two primary types of autosomal dominant osteopetrosis (ADO), osteopetrosis type II is characterized by sclerosis of bones, predominantly involving the spine, the pelvis, and the skull base. Fragility of bones and dental abscess are leading complications. This report presents a case of osteopetrosis in a 52-years-old female, which was complicated by the development of cavernous sinus thrombophlebitis and meningitis. She was suffered from multiple fractures since one year ago. Laboratory data revealed elevated serum levels of tartrate resistant acid phosphatase (TRAP) without carbonic anhydrase II DNA mutation. A thoracolumbar spine X-ray showed, typical findings of ADO type II (ADO II; Albers-Schönberg disease), prominent vertebral endplates so called the 'rugger jersey spine'. Her older sister also showed same typical spine appearance. We report a case of ADO II with cavernous sinus thrombophlebitis and meningitis that was successfully treated with long-term antibiotics with right sphenoidotomy.

Cavernous Sinus Thrombophlebitis Related to Dental Infection

Two cases of cavernous sinus thrombophlebitis (CST) caused by dental infection are described. A 64-year-old woman presented with palsies of the left oculomotor and trochlear nerves after tooth extraction for dental caries in the left maxilla. A 54-year-old man presented with palsy of the left trochlear nerve, sensory disturbance in the ophthalmic and maxillary divisions of the left trigeminal nerve, ptosis, proptosis, and chemosis after dental treatment for caries and periodontitis in the left maxilla. In both patients, computed tomography and magnetic resonance imaging with contrast medium showed non-enhanced lesions within the left cavernous sinus and dilation of the superior ophthalmic veins, which indicated CST. These conditions were resolved by administration of broad-spectrum antibiotics. CST is rare but lethal, so prompt diagnosis is crucial, and immediate appropriate treatment is essential.

Black turbinate sign: a potential predictor of mucormycosis in cavernous sinus thrombophlebitis

1 Fellow in Neuroradiology, Santa Casa de Misericordia de Sao Paulo, Sao Paulo SP, Brazil; 2 Section of Neuroradiology, Santa Casa de Misericordia de Sao Paulo, Sao Paulo SP, Brazil. Correspondence: Antonio Jose da Rocha; Rua Cincinato Braga 232; 01333-910 Sao Paulo SP Brasil Conflict of interest: There is no conflict to interest to declare. Received 24 August 2011; Received in final form 15 September 2011; Accepted 23 September 2011 Rhinosinusitis has the potential to result in catastrophic intracranial extension in the presence of predisposing conditions, such as diabetes, immunosuppression (fungus) or the incomplete treatment of bacterial infection. It is assumed that cavernous sinus thrombophlebitis (CST) is secondary to retrograde extension due to a valveless system of the vein that communicates paranasal cavities to the cavernous sinus1. The “black turbinate sign” results from dry gangrene in affected Figure. Mucormycosis exhibiting “black turbinate sign” that is characterized by low signal intensity (large arrow) of the right inferior nasal turbinate on the coronal T2 image (A) and the absence of enhancement (large arrows) after intravenous gadolinium administration on coronal (B) and axial (C) T1 images; note the typical ipsilateral CST (small arrows). The lack of these features can be observed in the comparative images of bacterial rhinosinusitis associated with bilateral CST (arrows in D-F). Both patients had additional orbital compromise. A B C F E D