Cavernous sinus thrombosis: An insidious and dangerous “do‐not‐miss” diagnosis

Qu, Huiyang; Li, Yanling; Chen, Mengying; Sun, Honghong; Du, Shuang; Cheng, Yuxuan; Zhan, Shuqin

doi:10.1111/head.14176

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…We describe the rare case of bilateral painful ophthalmoplegia possibly due to a unilateral aneurysm. The cavernous (C4) segment of the internal carotid artery is located medially within the cavernous sinus and is surrounded by a number of intracranial nerves, which includes the oculomotor nerve, trochlear nerve, abducent nerve, and ophthalmic and maxillary branches of the trigeminal nerve [ 7 ]. Therefore, an aneurysm of the cavernous segment of the internal carotid artery can cause retro-ocular pain, neuro-ophthalmic signs and symptoms which include diplopia, ophthalmoplegia, trigeminal neuropathy and so on.…”

Section: Discussionmentioning

confidence: 99%

Single internal carotid cavernous sinus aneurysm presented as bilateral painful ophthalmoplegia: a case report

et al. 2023

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Background Intracranial aneurysms are the most common vascular cause of painful ophthalmoplegia. Symptoms include retro-orbital pain, diplopia, ophthalmoplegia, trigeminal neuropathy, or a combination of these. Most single aneurysms cause ipsilateral, painful ophthalmoplegia. Here, we report the first, to our knowledge, case of bilateral painful ophthalmoplegia possibly caused by an aneurysm of the cavernous segment of the left internal carotid artery. Case presentation A 62-year-old male patient presented with headache and bilateral ptosis. Laboratory tests revealed hypopituitary function. Computerized tomography angiography showed a large aneurysm in the cavernous sinus segment of the left internal carotid artery. Aneurysm embolization was performed in the Nerve Interventional Department. Four months after surgery, the patient's symptoms returned to normal. Conclusions This case suggests that patients with bilateral painful ophthalmoplegia should be screened for aneurysms using computed tomography angiography or magnetic resonance angiography immediately.

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Section: Discussionmentioning

confidence: 99%

Single internal carotid cavernous sinus aneurysm presented as bilateral painful ophthalmoplegia: a case report

et al. 2023

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“…SCST often needs to be differentiated from pituitary apoplexy, carotid cavernous fistula, and periorbital cellulitis. [12] The most common symptoms of SCST are periorbital edema and proptosis, followed by headache and cranial nerve palsies (III, VI, V1, and V2). Other clinical signs of SCST include bilateral progressive ocular symptoms, sepsis, altered state of consciousness, loss of vision, and dilated retinal veins.…”

Section: Discussionmentioning

confidence: 99%

Septic cavernous sinus thrombosis presenting as acute cerebral infarction and aneurysmal subarachnoid hemorrhage: Case report

He,

Li,

Jiang

2023

Medicine

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Rationale: Septic cavernous sinus thrombosis (SCST) is a rare infectious thrombophlebitic disease. The infection often arises from the tissues surrounding the cavernous sinus as well as the cavernous sinus drainage. Early symptoms of SCST include fever, headache, proptosis, ptosis, bulbar conjunctival edema, and limited eye movement. The complications include venous sinus thrombosis, intracerebral abscess, and subdural empyema. Aneurysmal subarachnoid hemorrhage combined with acute cerebral infarction has not been reported. Patient concerns: A 46-year-old man presented with visual impairment in his right eye and intermittent headache for 2 months. Ten days later, the patient developed a sudden loss of consciousness, coma, cardiac arrest, and respiratory arrest. The patient eventually died. Diagnoses: SCST, acute cerebral infarction, aneurysmal subarachnoid hemorrhage, anterior cerebral artery aneurysm. Interventions: Antiplatelet and lipid-lowering therapy, antibiotic treatment, emergency aneurysm clipping, and decompressive craniectomy. Outcomes: The patient underwent emergency aneurysm clipping and decompressive craniectomy, and postoperative head computed tomography showed a massive cerebral infarction in the right cerebral hemisphere. The patient eventually died. Lessons: We report a case of SCST mainly presenting as acute cerebral infarction and aneurysmal subarachnoid hemorrhage, with an acute onset and ultimately a poor prognosis. This complication is extremely rare and have not yet reported according existing literatures but can be life-threatening if not recognized and treated promptly. Early antibiotic administration and early sinus drainage may alter the patient’s prognosis. By describing this unusual the case we hope to raise awareness of the need of early illness detection and treatment in order to avoid catastrophic consequences. It also exemplifies the mechanism of acute inflammatory disorders and aneurysm development.

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