Cavernous Sinus Thrombosis in Children

Abstract

Patients were included if aged between 1 month and 18 years, diagnosed with CST, and seen at Children's Hospital Colorado at either presentation or follow-up with imaging available for review.Background and Purpose-Cavernous sinus thrombosis (CST) is a rare life-threatening cerebrovascular disease known to cause carotid artery narrowing (CAN) and arterial ischemic stroke. The imaging features of CST and related complications have been reported in adults, but rarely in children. Methods-We performed a retrospective review of children with imaging confirmed CST from 2003 to 2014, describing presenting symptoms, imaging findings, and treatment. Results-Ten patients with CST were identified. All had CAN and 6 of 10 developed infarcts. Of 8 patients treated with anticoagulation therapy, 3 developed new infarcts. None required discontinuation of anticoagulation therapy because of bleeding. Visual impairment secondary to infectious neuritis was common. Imaging characteristics include cavernous sinus expansion, filling defects, restricted diffusion, arterial wall enhancement, empyema, superior ophthalmic vein enlargement and thrombosis, orbital cellulitis, and pituitary inflammation. CAN resolved in 60% of cases. Outcomes were mostly good, with a modified Rankin Scale score of ≤1 for 7 of 10 patients at discharge and 1 death. Conclusions-CAN and infarcts were common in this modest cohort of children with CST. Despite the high incidence of CAN and infarction, outcomes were often favorable. Although this is the largest cohort of childhood CST reported to date, large multicenter cohorts are needed to confirm our findings and determine the preferred therapeutic strategies for childhood CST.

Methamphetamine Injection Into Face Causing Fatal Cavernous Sinus Thrombosis

“…Presenting symptoms include impaired extraocular movement (due to compression of cranial nerves 3, 4, and 6). Compression of the ophthalmic and maxillary branches of the fifth cranial nerve can cause periorbital sensory loss, and problems related to venous drainage of the orbit can result in headache, photophobia, proptosis, painful eye movement, and periorbital edema 4,5 …”

Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review

“…Indirect signs, caused by venous obstruction, are dilatation of the superior ophthalmic vein, exophthalmos, and increased dural enhancement of the border of the cavernous sinus [ 17 ]. Associated findings are secondary thrombosis (for example of the superior ophthalmic vein, petrosal sinus, sphenoparietal sinus and sigmoid sinus) and narrowing of the internal carotid artery [ 17 , 18 ]. These findings were also frequently found in our series.…”

Cavernous Sinus Thrombosis in Children

“…The most common cause is acute sinusitis. Infections of the middle third of the face were responsible for most septic CST in the pre-antibiotic era though incidence has significantly decreased with the advent of antibiotic [ 3 ]. Aseptic CST is due to trauma or a pro-thrombotic etiology [ 3 ].…”

“…Compression of cranial nerves III, IV, and VI result in impaired extraocular movement with sixth nerve paresis being the most common.3 Compression of the ophthalmic and maxillary branches of cranial nerve V result in facial sensory deficits, periorbital sensory loss, and/or an impaired corneal reflex [ 3 ]. Unilateral periorbital edema, headaches, photophobia, chemosis, and proptosis are classic signs due to impaired venous drainage of the orbit [ 3 , 4 ]. Papilledema, retinal hemorrhages, worsening visual acuity or blindness may also occur due to impaired venous drainage with resulting retinal congestion.…”

“…Papilledema, retinal hemorrhages, worsening visual acuity or blindness may also occur due to impaired venous drainage with resulting retinal congestion. Progression to bilateral orbital involvement due to an intercavernous communication, meningitis, subdural empyemas, and sepsis are common in CST [ 3 ]. Presence of Horner syndrome and sixth nerve paresis classically localize to the cavernous sinus.…”