Septic Cavernous Sinus Thrombosis Complicated by Narrowing of the Internal Carotid Artery, Subarachnoid Abscess and Multiple Pulmonary Septic Emboli

Hoshino, Chisho; Satoh, Noriyuki; Sugawara, Shinichi; Kuriyama, Chizuko; Kikuchi, Akio; Ohta, Makoto

doi:10.2169/internalmedicine.46.6202

Cited by 31 publications

(16 citation statements)

References 20 publications

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“…24,25 Our cohort establishes that this is a common occurrence. Every patient who had narrowing of the ICA during the acute phase of the illness had an improved appearance on follow-up imaging, and for 70% of cases the narrowing resolved within 6 months.…”

Section: Figure 1 Contrast Vs Noncontrast Head Ctmentioning

confidence: 56%

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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Section: Figure 1 Contrast Vs Noncontrast Head Ctmentioning

confidence: 56%

Pediatric cavernous sinus thrombosis

et al. 2015

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“…1) We performed cerebral angiography in Case 1 to exclude other distinguishing diseases such as carotid-cavernous sinus fistula. Abnormal findings of the internal carotid artery such as stenosis, occlusion, or aneurysm have been observed in patients with CST, 1,6,7,9) and angiography in Case 1 showed irregularity of the left internal carotid artery in the arterial phase, possibly indicating arteritis, spasm, or thrombosis.…”

Section: Discussionmentioning

confidence: 86%

Cavernous Sinus Thrombophlebitis Related to Dental Infection

Okamoto

Ogata

Kosugi

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Two cases of cavernous sinus thrombophlebitis (CST) caused by dental infection are described. A 64-year-old woman presented with palsies of the left oculomotor and trochlear nerves after tooth extraction for dental caries in the left maxilla. A 54-year-old man presented with palsy of the left trochlear nerve, sensory disturbance in the ophthalmic and maxillary divisions of the left trigeminal nerve, ptosis, proptosis, and chemosis after dental treatment for caries and periodontitis in the left maxilla. In both patients, computed tomography and magnetic resonance imaging with contrast medium showed nonenhanced lesions within the left cavernous sinus and dilation of the superior ophthalmic veins, which indicated CST. These conditions were resolved by administration of broad-spectrum antibiotics. CST is rare but lethal, so prompt diagnosis is crucial, and immediate appropriate treatment is essential.

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“…[1] Neurological sequelae may occur uncommonly in the form of ophthalmoplegia, blindness, hemiparesis and pituitary insufficiency. [2] Involvement of the ICA is uncommon and occurs in the form of stenosis, occlusion and aneurysm formation. [2,3] Although the location of the ICA within the cavernous sinus may indicate that its involvement is likely in cases of CST, in practice, it is seldom seen.…”

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confidence: 99%

“…[2] Involvement of the ICA is uncommon and occurs in the form of stenosis, occlusion and aneurysm formation. [2,3] Although the location of the ICA within the cavernous sinus may indicate that its involvement is likely in cases of CST, in practice, it is seldom seen. The inflammation involves the arterial wall, leading to stenosis, luminal thrombosis and aneurysm formation due to the weakening of the wall.…”

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confidence: 99%