Neurological complications in two children with Lemierre syndrome

Abstract

Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14‐year‐old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the ‘clival syndrome’. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15‐year‐old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6‐week course of antibiotics and anticoagulants leading to almost full recovery at 3‐month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this ‘forgotten disease’.

Isolated abducens nerve palsy secondary to Lemierre syndrome

“…6 Combined involvement of the abducens and hypoglassal nerves, also known as "clival syndrome," has been described in children. 7 However, isolated abducens nerve palsy has not, to our knowledge, been previously described in a child.…”

“…7 Septic emboli may occur in lungs, joints, kidneys , skin, bones, and meninges. 7 Lemierre's syndrome has been recognized as an important cause of acute cranial nerve palsy. Infection-induced nerve palsies usually develop either from direct extension through the facial plane between the tonsils and the parapharyngeal space or by hematogenous or lymphatic spread from peritonsillar vessels.…”

Clival osteomyelitis and hypoglossal nerve palsy—rare complications of Lemierre's syndrome

“…In one case, osteomyelitis of the clivus required surgical drainage of a posterior pharyngeal collection 6. There have also been two documented reports of development of clival syndrome with palsies of the 6th and 12th cranial nerves associated with extensive cervical leptomeningitis followed by epidural abscess formation in children 7. Partial recovery of the cranial nerve function was achieved after conservative treatment with intravenous antibiotic therapy.…”

To anticoagulate? Controversy in the management of thrombotic complications of head & neck infections

“…Articles from 2002 to May 2014 were reviewed to identify studies, which met the inclusion criteria. Pediatric case reports (n=61; ) and case series (n=6; [64][65][66][67][68][69] were reviewed to identify a total of 80 individual cases. Patient ages ranged from 5 months to 17 years (average age: 11.8 years).…”