Orbital apex syndrome in a child

Sasindran, Vivek; Ravikumar, A.; Senthil,

doi:10.1007/s12070-008-0020-2

Cited by 14 publications

(11 citation statements)

References 6 publications

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“…Despite their rarity, the 3 reported cases of CST associated with positive fungal cultures had very high morbidity and mortality, including one death and 2 cases of impaired vision. All cases of fungal CST were associated with comorbidities like acute lymphoblastic leukemia, 13 recent steroid use, 16 and poorly controlled diabetes. 17 No other culture result seemed to be associated with outcome.…”

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confidence: 99%

Pediatric cavernous sinus thrombosis

et al. 2015

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Objective: To describe clinical characteristics, imaging findings, morbidity, and mortality in a single-center cohort of 12 pediatric cavernous sinus thrombosis cases and to review all cases available in recent English literature.Methods: Clinical data and radiographic studies on 12 cases from our institution were analyzed retrospectively. A literature search and review was conducted, with additional cases pooled with the new cohort for an aggregate analysis.Results: Twelve cases of cavernous sinus thrombosis in children from the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2013, were reviewed. All patients survived to discharge; 3 of 12 (25%) experienced neurologic morbidity. Contrast-enhanced MRI and contrast-enhanced head CT were 100% sensitive for detecting cavernous sinus thrombosis, while noncontrast time-of-flight magnetic resonance venography (TOF MRV) and noncontrast head CT were 0% sensitive. Literature review produced an additional 40 cases, and the aggregate mortality rate was 4 of 52 (8%) and morbidity rate was 10 of 40 (25%). Outcomes did not vary by treatment or with unilateral vs bilateral cavernous sinus involvement. There was a trend toward worse outcomes with fungal infections. Conclusion:Our case series demonstrates low morbidity and mortality with early, aggressive surgical, antimicrobial, and anticoagulation therapies. Although anticoagulation and surgery were not associated with significantly different outcomes, more study is needed. Neurology ® 2015;85:763-769 GLOSSARY CST 5 cavernous sinus thrombosis; ICA 5 internal carotid artery; MRA 5 magnetic resonance angiography; MRV 5 magnetic resonance venography; TOF MRV 5 time-of-flight magnetic resonance venography without contrast.

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confidence: 99%

Pediatric cavernous sinus thrombosis

et al. 2015

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“…Other patients were treated with either amphotericin B or its combination with itraconazole[ 12 , 14 ] also with encouraging results. While voriconazole was shown effective and well tolerated [ 6 ], the present case represents the fifth where it was used alone for treatment of orbital aspergillosis [ 15 – 18 ]; in these few cases, as in ours, the therapy was successful. Amphotericin B is decreasingly relevant due to frequent reports of nephrotoxicity [ 6 ].…”

Section: Discussionmentioning

confidence: 65%

Orbital aspergillosis: a case report and review of the literature

et al. 2021

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Background Orbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to its unspecific clinical and radiologic appearance. Therapeutic delay can have dramatic consequences. However, progress in microbiological diagnostic techniques and therapeutic experience from case series help improve the management of this disease. Case presentation A 78-year-old immunocompetent woman presented at an eye clinic for subacute swelling, reddening, and ptosis of her left upper eyelid. Based on radiologic and histologic considerations, she was treated for idiopathic orbital inflammation, but her condition worsened. After a second biopsy of the orbital mass, aspergillosis was diagnosed. Her condition improved promptly after initiation of an oral voriconazole treatment. Additionally, using a polymerase chain reaction (PCR) assay, A. fumigatus was identified on tissue of both biopsies and its azole susceptibility was examined simultaneously. Conclusions In the case described here, oral antifungal treatment was sufficient for the therapy of invasive orbital aspergillosis. Performing fungal PCR on orbital tissue can accelerate the diagnostic process and should be performed in ambiguous cases of slowly growing orbital mass. Finally, interdisciplinary management is the key to optimal treatment of orbital tumours and infections.

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“…They are better tolerated with less systemic adverse effects than amphotericin B. [ 23 , 25 ] However, there is no prospective study comparing them for invasive aspergillosis. Surgical resection accompanied by antifungal medication is advised currently.…”

Section: Discussionmentioning

confidence: 99%

Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor

Chang¹,

Chang²,

Chien³

et al. 2018

Medicine

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Rationale:Orbital apex syndrome is a complex clinical disorder featuring a collection of cranial nerve deficits characterized by impairment of the extraocular muscles, the ophthalmic branch of the trigeminal nerve, and even the optic nerve. Sino-orbital aspergillosis is rare but aggressive infection. Surgical resection accompanied by antifungal medication is advised currently.Patient concerns:We report a 61-year-old woman diagnosed as aspergilloma presenting with the characteristic manifestations and imaging features of orbital apex syndrome.Diagnoses:Paranasal sinus tumor was misdiagnosed initially according to magnetic resonance imaging of the orbit. Finally aspergilloma was diagnosed by pathologic report.Interventions:The anti-fungal medication, voriconazole, was administered immediately. Surgical excision was also done due to the poor response to medical treatment.Outcomes:Postoperative follow-up showed no recurrence of aspergillosis but the vision was lost permanently.Lessons:Invasive sino-orbital aspergillosis as an aggressive disease with highly invasive patterns and it may be misdiagnosed as tumors. To achieve better prognosis and survival, clinicians should be aware of this distinct manifestation.

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Orbital apex syndrome in a child

Cited by 14 publications

References 6 publications

Pediatric cavernous sinus thrombosis

Pediatric cavernous sinus thrombosis

Orbital aspergillosis: a case report and review of the literature

Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor

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