Cavernous Sinus Thrombosis : A Case Report

International Journal of Clinical Case Reports and Reviews

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.

Journal of Oral Diagnosis, 2022

Cavernous Sinus Thrombosis (CST) is an uncommon neurological infection that affects the cavernous sinus of the dura mater, which can lead to death. When untreated, odontogenic infections can cause CST, since facial veins do not have valves. The diagnosis consists of the clinical characteristics added to imaging exams such as computed tomography (CT) and magnetic resonance imaging (MRI). The effectiveness of antibiotic therapy in significantly reducing mortality has been proven, but therapy with anticoagulants and corticosteroids remains unknown in the literature. Objective: The purpose of the study is to make a literature review on etiology, paraphysiology, symptoms, complementary exams, diagnosis and outcome of patients who presented CST as a result of an odontogenic infection. Materials and methods: a literature review was carried out, using articles from the Pubmed, Lilacs and Cochrane databases, from the last 10 years in the English language and reference articles to complement. The Mesh terms used were 'Cavernous Sinus Thrombosis', 'Cavernous Sinus Thrombosis AND Odontogenic Infections' and 'Cavernous Sinus Thrombosis AND Dental Infection'. Conclusion: CST motivated by odontogenic infections is a rare but extremely dangerous disorder that must be discovered early in order for the patient's prognosis to be favorable. It is necessary to pay attention to the clinical signs and to the analysis of the imaging exams so that the differential diagnosis is made.

2016

The aim of this study was to review the literature regarding septic cavernous sinus thrombosis of odontogenic origin. Searches were made of the electronic databases and reference lists of the pertinent articles between 1990 and 2015. The search strategy produced 161 references, which included 15 studies that fulfilled the inclusion criteria. The literature review showed that the odontogenic focus occurs most frequently from a dental abscess and is related mainly to the third molar followed by the second molar. Dissemination of the infection was observed for the buccal, pterygomandibular, infratemporal and parapharyngeal spaces. Swelling was the most frequent symptom and pseudomonas aeruginosa was the most common infectious agent. Drug treatment has generally been administered using combinations, with vancomycin being the most frequently used. In surgical treatment, patients underwent abscess drainage and dental extraction. It was observed that fewer than 50% of the patients had full...

Journal of the Korean Association of Oral and Maxillofacial Surgeons, 2017

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive ant...

Cavernous sinus thrombosis (CST) secondary related to maxillofacial infection is a rare clinical squeale.The CST is a rare disease which is reported to how high rate of morbidity and mortality.Cavernous sinus thrombosis not only presents with symptoms of infections which includes fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. The prompt diagnosis and timelytreatment of CST is very important for successful outcome. The infectionin maxillofacial region shouldbe given due attention, as to prevent CST. In this case report, we highlighted the role of Odontogenic abscess leads to CST, facial palsy, and loss of vision. The Odontogenic infection should never be neglectedas in rare instances it may cause serious intracranial complication like CST.

Romanian Journal of Morphology and Embryology, 2020

Cavernous sinus thrombosis (CST) usually produces a characteristic clinical syndrome. Septic CST represents a sporadic, but severe complication of infection of the cavernous sinuses, which can bring high mortality and morbidity rates if not treated right away. Case presentation: The current research is a case report of a 64-year-old woman with inherited thrombophilia who developed an acute mastoid infection that resulted in septic right CST. The clinical diagnosis was verified by laboratory studies and evidence from high-resolution computed tomography (HRCT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Clinical medical care resulted in the patient being successfully treated with low-molecular-weight heparin and broad-spectrum intravenous antibiotics, which avoided severe complications.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010

Neglect of odontogenic infections can have serious consequences. If they spread through fascial planes and intracranially they can cause an abscess, orbital cellulitis, and eventually cavernous sinus thrombosis. The authors report a case of rapid progressive bilateral orbital cellulitis and cavernous sinus thrombosis that originated from dental caries. Septic cavernous sinus thrombosis is a medical emergency. Early recognition and prompt treatments direct to the underlying sources of infection are crucial. Broad-spectrum intravenous antibiotics are the mainstay of treatment to reduce morbidity and mortality from this lethal condition. Management should be based on early diagnosis and prompt management with intravenous broad-spectrum antibiotics and surgical intervention.

Pediatric Critical Care Medicine, 2004

Invasive fungal rhinosinusitis is one of the less frequent forms of fungal rhinosinusitis. It occurs in immunocompromised patients (AIDS, hematologic diseases, type 1 diabetes mellitus) with a fatal outcome if not treated. We report a case of an unusual presentation of invasive fungal sinusitis in which a 40yr old male diabetic patient presented to us primarily with ophthalmic symptoms without nasal symptoms, suggestive of cavernous sinus thrombosis. This paper emphasizes the need for the clinicians to keep this diagnosis in mind when managing an immunocompromised patient presenting with ocular symptoms or cranial nerve palsies, as in such cases, early diagnosis may be the most important step in successful treatment of the patient.

Cureus, 2022

A 32-year-old gentleman with underlying hypertension presented with left eye ptosis and diplopia for two weeks. He also complained of the left eye progressive blurring of vision. One week of left-sided toothache, headache, and fever preceded these symptoms. He visited a dental clinic for the toothache and was prescribed oral metronidazole before scheduling tooth extraction. However, the disease progressed with ocular symptoms. On examination, his visual acuity was 20/20 on the right and perception to light on the left. The left eye pupil was sluggish, and relative afferent pupillary reflex was positive. There was partial ptosis, mild proptosis, and ophthalmoplegia involving cranial nerve III, IV, and VI over the left. Hypoesthesia over the left V1 region was also present. Bilateral anterior and posterior segments were unremarkable. Blood investigations revealed an elevated total white cell count and C- reactive protein. Hence, an urgent computed tomography of the brain was requested...