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Housley SB, McPheeters MJ, Raygor KP, Bouslama M, Scullen T, Davies JM. Cavernous Sinus Thrombosis. Neurosurg Clin N Am 2024; 35:305-310. [PMID: 38782523 DOI: 10.1016/j.nec.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cavernous sinus thrombosis is a potentially lethal subset of cerebral venous sinus thrombosis that may occur as a result of septic and aseptic etiologies. The overall incidence is estimated to be between 0.2 and 1.6 per 100,000 persons; and treatments include antibiotics, anticoagulation, corticosteroids, and surgery. Recent morbidity and mortality estimates are approximately 15% and 11%, respectively. Rapid identification and treatment are essential and may reduce the risk of poor outcome or death.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Mehdi Bouslama
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Tyler Scullen
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA.
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2
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Reynolds AS. Neuroinfectious Emergencies. Continuum (Minneap Minn) 2024; 30:757-780. [PMID: 38830070 DOI: 10.1212/con.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article describes nervous system infections and complications that lead to neurologic emergencies. LATEST DEVELOPMENTS New research on the use of dexamethasone in viral and fungal infections is reviewed. The use of advanced MRI techniques to evaluate nervous system infections is discussed. ESSENTIAL POINTS Neurologic infections become emergencies when they lead to a rapid decline in a patient's function. Emergent complications may result from neurologic infections that, if not identified promptly, can lead to permanent deficits or death. These complications include cerebral edema and herniation, spinal cord compression, hydrocephalus, vasculopathy resulting in ischemic stroke, venous thrombosis, intracerebral hemorrhage, status epilepticus, and neuromuscular respiratory weakness.
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Halawa O, Gibbons A, Van Brummen A, Li E. Septic Cavernous Sinus Thrombosis: Clinical Characteristics, Management, and Outcomes. J Neuroophthalmol 2024:00041327-990000000-00628. [PMID: 38654412 DOI: 10.1097/wno.0000000000002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Septic cavernous sinus thrombosis (CST) is a rare condition traditionally associated with high morbidity and mortality. More recent case series report more favorable outcomes, including full functional recovery. A comprehensive assessment of the clinical characteristics and prognostic factors of visual and survival outcomes in septic CST is warranted to contemporize current understanding and help guide management. METHODS A multicentered retrospective cohort study was conducted at 2 tertiary care centers using an electronic medical record search of the term, "thrombosis of cavernous venous sinus" between January 1, 2000, and December 31, 2021. Inclusion criteria consisted of active infection and radiographic evidence of associated CST. Demographic and clinical data extracted included age at presentation, sex, infection type and extent, and ophthalmic examination findings at presentation-best-corrected visual acuity (BCVA), presence of relative afferent pupillary defect (RAPD), intraocular pressure (IOP), and extraocular motility (EOM) limitation. Management data collected consisted of type and length of antimicrobial therapy, type and length of anticoagulation administration, and surgical intervention. Primary outcomes assessed were ophthalmic examination findings at final evaluation and same-hospitalization mortality. RESULTS A total of 27 patients with imaging-confirmed septic CST were identified at 2 tertiary care centers. At presentation, 2 (8.7%) patients had no light perception (NLP) vision, 8 (29.6%) patients had RAPD, 17 (73.9%) patients had EOM limitation, and 13 (54.2%) had IOP >21 mm Hg. All patients received antimicrobial therapy, with vancomycin being the most common agent. Fifteen patients (55.6%) received anticoagulation, and 21 (81.5%) patients underwent surgical intervention. Same-hospitalization mortality was 3 (11.1%). Among the 21 patients with ophthalmic data at follow-up, 3 (16.7%) had NLP vision, 5 (23.8%) had a persistent RAPD, 7 (31.8%) had persistent EOM limitation, and no patients had IOP elevated above 21 mm Hg. Patients with RAPD at presentation had significantly worse BCVA at final evaluation (logMAR BCVA 1.43 higher on average, P = 0.01) and a significantly higher mortality rate (37.5% vs. 0.0%, P < 0.01) than non-RAPD patients. Demographic features, BCVA at presentation, EOM limitation at presentation, elevated IOP at presentation, and comorbid orbital cellulitis were not associated with worse visual or mortality outcomes. CONCLUSIONS Septic CST may result in permanent ophthalmic functional deficit in almost one-third of cases and mortality in approximately 11% of patients under contemporary management. New RAPD at presentation may indicate higher risk of poor visual and survival outcomes.
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Affiliation(s)
- Omar Halawa
- Wilmer Eye Institute (QH, AG, EL), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Ophthalmology (AVB), University of Washington School of Medicine, Seattle, Washington
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Colantonio MA, Arvon JN, Koenig N, Hendricks E, Abdullah A. SARS-CoV-2 associated septic venous cavernous sinus thrombosis: A case report. Radiol Case Rep 2024; 19:1090-1092. [PMID: 38229599 PMCID: PMC10789928 DOI: 10.1016/j.radcr.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024] Open
Abstract
Cavernous sinus thrombosis (CST) is a life-threatening condition occurring due to an active infection, coagulation abnormalities, and trauma. Thromboembolic events are known complications secondary to novel coronavirus disease-19 (COVID-19) due to dysfunction in endothelial function and clotting factor dysfunction. We report a case of cavernous sinus thrombosis and delayed ophthalmic vein thrombosis associated with a preceding COVID-19 infection confirmed with a facial computed tomography (CT) scan. Clinicians should have a broad differential in patients with hypercoagulable states, as complications secondary to COVID-19 can be life-threatening.
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Affiliation(s)
- Mark A. Colantonio
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Jessica N. Arvon
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Nicholas Koenig
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Emily Hendricks
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Amirahwaty Abdullah
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV 26506 USA
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Borhani-Haghighi A, Hooshmandi E. Cerebral venous thrombosis: a practical review. Postgrad Med J 2024; 100:68-83. [PMID: 37978050 DOI: 10.1093/postmj/qgad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases.
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Affiliation(s)
- Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
- Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
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Benish M, Shrot S, Barg A, Kventsel I, Elhasid R, Kenet G, Levy-Mendelovich S. Ocular venous occlusion in pediatrics: Should thrombophilia investigation and anticoagulant treatment be initiated? Pediatr Blood Cancer 2023; 70:e30689. [PMID: 37740614 DOI: 10.1002/pbc.30689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
Retinal vein occlusion (RVO) and superior ophthalmic vein thrombosis (SOVT) are rare diseases in the pediatric population; however, the ophthalmic and neurologic morbidity are significant. As published data are scarce for these conditions, we present our experience with pediatric ocular venous thrombosis in four patients, and discuss recommended management for evaluation and treatment. We suggest performing thrombophilia workup for all pediatric patients with RVO or SOVT. In patients with thrombophilia risk factors or patients with additional thrombi, we highly recommend initiating anticoagulation therapy. There is a need for more research in order to determine the optimal management strategy.
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Affiliation(s)
- Marganit Benish
- Department of Pediatric Hematology and Oncology, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shrot
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Assaf Barg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia and thrombosis Center, Amalia Biron thrombosis Research Institue, Sheba Medical Center, Ramat Gan, Israel
- Department of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Iris Kventsel
- Department of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ronit Elhasid
- Department of Pediatric Hematology and Oncology, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kenet
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia and thrombosis Center, Amalia Biron thrombosis Research Institue, Sheba Medical Center, Ramat Gan, Israel
| | - Sarina Levy-Mendelovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia and thrombosis Center, Amalia Biron thrombosis Research Institue, Sheba Medical Center, Ramat Gan, Israel
- Talpiot sheba leadership program, Sheba medical center, Ramat Gan, Israel
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Oragui C, Gonzalez L, Agha R. Pediatric Cavernous Sinus Thrombosis and COVID-19 Infection: Case Report. Clin Pediatr (Phila) 2023; 62:1461-1464. [PMID: 36919824 PMCID: PMC10018112 DOI: 10.1177/00099228231161024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Chika Oragui
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
| | - Lisandra Gonzalez
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
| | - Rabia Agha
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
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Guerin JB, Brodsky MC, Silvera VM. Infectious and Inflammatory Processes of the Orbits in Children. Neuroimaging Clin N Am 2023; 33:685-697. [PMID: 37741666 DOI: 10.1016/j.nic.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Most primary orbital pathology in children is due to bacterial infection. Radiologists typically encounter these cases to evaluate for clinically suspected postseptal orbital involvement. Contrast-enhanced cross-sectional imaging is important for the detection and early management of orbital infection and associated subperiosteal/orbital abscess, venous thrombosis, and intracranial spread of infection. Benign mass-like inflammatory processes involving the pediatric orbit are rare, have overlapping imaging features, and must be distinguished from orbital malignancies.
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Affiliation(s)
- Julie B Guerin
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester MN 55905, USA.
| | - Michael C Brodsky
- Department of Ophthalmology, Mayo Clinic, 200 1st Street SW, Rochester MN 55905, USA
| | - V Michelle Silvera
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester MN 55905, USA
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Kim TH, Bae SY. Posterior Nasal Septal Abscess Detected During Evaluation of Cavernous Sinus Thrombosis. J Craniofac Surg 2023; 34:e749-e752. [PMID: 37594253 DOI: 10.1097/scs.0000000000009617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 08/19/2023] Open
Abstract
Septic cavernous sinus thrombosis (CST) is a rare, life-threatening condition that commonly originates from sinusitis. Posterior nasal septal abscess (NSA) is an extremely rare cause of septic CST because it is a very rare condition by itself. Here we report a rare case involving an elderly woman with septic CST associated with a posterior NSA that was successfully treated without any sequelae. Incision and drainage of the posterior NSA were performed under local anesthesia, and the nasal packing was removed 2 days postoperatively. Pus from the abscess was sent for culture and sensitivity analyses, which revealed Enterococcus faecium . She was treated with intravenous (IV) third-generation cephalosporin (2 g twice daily) and IV vancomycin (0.75 g twice daily) for 4 weeks. IV low-molecular-weight heparin was administered at a dose of 40 mg twice daily for 4 days, followed by warfarin (3 mg once a day) for 21 days. The patient was discharged without any sequelae after 4 weeks. At the 2-month follow-up, she did not complain of any further symptoms. The findings from this case suggest that clinicians should maintain a high index of suspicion and provide prompt treatment to prevent mortality and morbidity associated with septic CST.
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Affiliation(s)
- Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Fatima Hospital
| | - Seong Yoon Bae
- Department of Neurology, Daegu Fatima Hospital, Daegu, Republic of Korea
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10
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Fikriyah L, Hidayati HB, Ardhi MS. Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report. Ann Med Surg (Lond) 2023; 85:946-950. [PMID: 37113961 PMCID: PMC10129092 DOI: 10.1097/ms9.0000000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/22/2022] [Indexed: 04/29/2023] Open
Abstract
Cavernous sinus thrombosis (CST) is an unusual condition that can result in high mortality and morbidity rate if not treated immediately. Case presentation An Indonesian male, 47 years old, presented with total right ocular ophthalmoplegia followed by blindness, headache, ptosis, periorbital swelling, and hypoesthesia over the left V1 region. MRI of the brain showed suitable cavernous thickening until the right orbital apex, which in contrast showed enhancement suggestive of right Tolosa-Hunt syndrome. The patient was treated with a high dose of steroids, but the patient's complaints did not improve. The patient underwent digital subtraction angiography and found CST. The optical coherence tomography was found to be central serous chorioretinopathy. He was treated with an antibiotic, anticoagulant, and extraction of the right maxillary molar was performed to remove the source of the infection. After 3 weeks, visual acuity and optical coherence tomography examination were improved. Discussion A comprehensive examination, such as digital subtraction angiography, is essential to confirm CST diagnosis for the patient to obtain the right therapy. This report highlighted the value of the prompt diagnosis of CST through neuroimaging and the importance of proper therapy in patient management. Conclusions Early diagnosis, comprehensive examination, and proper treatment of CST will increase good prognosis.
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Affiliation(s)
| | - Hanik Badriyah Hidayati
- Corresponding author: Department of Neurology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Jalan Mayjend Prof. Dr. Moestopo No. 6-8, Airlangga, Gubeng, Surabaya, East Java, 60286, Indonesia. Tel.: +6231-5501670; fax: +6231-5022472. E-mail address: (H.B. Hidayati)
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New Insights into the Communications of the Facial Vein with the Dural Venous Sinuses. Medicina (B Aires) 2023; 59:medicina59030609. [PMID: 36984610 PMCID: PMC10052974 DOI: 10.3390/medicina59030609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
Background and Objectives: Anastomoses of the extracranial and intracranial venous system have been described in the literature. The presence of such anastomoses may facilitate a possible spread of infection into the dural venous sinuses. However, the frequency and relevance of such anastomoses is highly debated. The aim of this study was to quantify frequencies of anastomoses between the facial vein and the dural venous sinuses. Materials and Methods: In 32 sides of 16 specimens, latex was injected into the facial vein. Dissection was carried out to follow and described these anastomoses, yielding the presence of latex in the intracranial venous system. Results: In 97% of cases, a dispersal of latex into the cavernous sinus as well as anastomoses was observed. A further dispersal of latex into other dural venous sinuses was found at rates ranging between 34% (transverse sinus)—88% (superior petrosal sinus), respectively. Conclusions: The presence of anastomoses between the extracranial and intracranial venous system in a majority of cases needs to be considered when dealing with pathologies as well as procedures in the facial region.
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Jih WA, Shukla T, Gillespie J, Chapman PR. Cavernous sinus and jugular thromboses, base of skull osteomyelitis and cranial nerve palsies: catastrophic complications of sphenoid sinusitis. BMJ Case Rep 2023; 16:16/2/e253496. [PMID: 36731941 PMCID: PMC9896245 DOI: 10.1136/bcr-2022-253496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Sphenoid sinusitis is a clinically important entity as it may be associated with catastrophic complications including cavernous sinus thrombosis (CST), cerebral abscess or infarction, meningitis, base of skull osteomyelitis and cranial nerve palsies. We report a case of occult sphenoid sinusitis presenting as Streptococcus intermedius bacteraemia, bilateral jugular vein and CST, cranial nerve palsy and base of skull osteomyelitis.
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Affiliation(s)
- Wen-An Jih
- Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Tej Shukla
- Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jennifer Gillespie
- Medical Imaging, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia,School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Paul Robert Chapman
- Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia,Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
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Baudouin R, Couineau F, Hans S. Beware of proptosis even if contralateral to sphenoiditis. J Fr Ophtalmol 2023; 46:e99-e101. [PMID: 36604212 DOI: 10.1016/j.jfo.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 01/04/2023]
Affiliation(s)
- R Baudouin
- Department of Otolaryngology - Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone-Veil, université Versailles - Saint-Quentin-en-Yvelines, Paris Saclay, France.
| | - F Couineau
- Department of Otolaryngology - Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone-Veil, université Versailles - Saint-Quentin-en-Yvelines, Paris Saclay, France
| | - S Hans
- Department of Otolaryngology - Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone-Veil, université Versailles - Saint-Quentin-en-Yvelines, Paris Saclay, France
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Xiong J, Liu H, Li J, Hou J, Cui F. Case report: 18F-FDG PET confirmed pupil-sparing third nerve palsy heralding aseptic cavernous sinus embolism in patient with chest malignancy. Front Surg 2022; 9:893651. [PMID: 36117807 PMCID: PMC9471138 DOI: 10.3389/fsurg.2022.893651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Classical cavernous sinus embolism is a rare clinical finding, presented most commonly by complaints of headache, diplopia, visual field defects, facial pain, and progressive neurological deficits. Many patients exhibit symptoms of III, IV, and VI nerve palsies. We hereby report a rare case of aseptic cavernous sinus embolism developed in a 75-year-old male with primary lung cancer who presented with binocular diplopia due to unilateral third and sixth cranial nerve palsies with pupil-sparing. The possibility of cavernous sinus cancer embolus should be considered if the routine examination excluded metastases, infiltration, carcinomatous meningitis, or the paraneoplastic process. 18F-FDG PET imaging may provide a promising diagnostic modality for the diagnosis of cancer embolus.
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Affiliation(s)
- Jianmei Xiong
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Huanbo Liu
- Department of Cardiology, The Second Navy Hospital of Southern Theater Command of PLA, Hainan, China
- Correspondence: Huanbo Liu Fang Cui
| | - Jianyong Li
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Jiajia Hou
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Fang Cui
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
- Correspondence: Huanbo Liu Fang Cui
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Carvalho dos Santos P, Costa P, Carvalho I, Sousa C. Complicaciones de la rinosinusitis aguda. Una revisión clínica radiológica. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Kim JM, Kang KW, Kim H, Lee SH, Kim TS, Park MS. Septic cavernous sinus thrombosis after minor head trauma: A case report. Medicine (Baltimore) 2022; 101:e29057. [PMID: 35451418 PMCID: PMC8913101 DOI: 10.1097/md.0000000000029057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition that commonly arises from infections, including paranasal sinusitis, otitis media, and skin infection. Meanwhile, head trauma as a predisposing factor of SCST has been scarcely reported. We report a case of SCST complicated by meningitis after minor head trauma, even in the absence of identifiable fractures. PATIENT CONCERNS AND DIAGNOSIS A 77-year-old female presented with diplopia combined with ocular pain and headache lasting a week. She had a recent blunt head trauma 2 weeks before the diplopia onset. The trauma was not accompanied by identifiable skull fractures, bleeding, or loss of consciousness. Neurological examination revealed incomplete ptosis, eyelid swelling, and medial and vertical gaze limitations of both eyes. Gadolinium-enhanced brain magnetic resonance imaging demonstrated multifocal thrombotic filling defects, including those of the cavernous sinus, sinusitis involving the sphenoid and ethmoid sinuses, and otomastoiditis. The cerebrospinal fluid assay result was compatible with bacterial meningitis. A tentative diagnosis of SCST complicated by bacterial meningitis and multifocal cerebral venous thrombosis was made based on clinical, laboratory, and neuroradiologic findings. INTERVENTION Intravenous triple antibiotic therapy (vancomycin, ceftriaxone, and ampicillin) for 2 weeks combined with methylprednisolone (1 g/d for 5 days) was administered. Despite the initial treatment, carotid-cavernous fistula was newly developed during hospitalization. Therefore, coil embolization was performed successfully for the treatment of carotid-cavernous fistula. OUTCOMES The symptoms of the patient including diplopia gradually improved during the 8-month follow-up period. LESSONS Minor head trauma is a rare but possible cause of SCST. Early recognition and prompt treatment are essential for improving outcomes. Moreover, close observation is warranted, even if apparent serious complications were absent during initial evaluations in minor head trauma.
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Affiliation(s)
- Jae-Myung Kim
- Department of Neurology, Chonnam National University Medical School & Hospital, Gwangju, South Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Medical School & Hospital, Gwangju, South Korea
| | - Hyunsoo Kim
- Department of Neurology, Chonnam National University Medical School & Hospital, Gwangju, South Korea
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Medical School & Hospital, Gwangju, South Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Medical School & Hospital, Gwangju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School & Hospital, Gwangju, South Korea
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17
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Rosa F, Renzetti P, Castellan L, Roccatagliata L. Cavernous sinus thrombosis associated with intraparenchymal hemorrhage and brainstem venous infarction as a rare complication of fronto-orbital infection. Neurol Sci 2021; 43:731-734. [PMID: 34664179 DOI: 10.1007/s10072-021-05658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- F Rosa
- Diagnostic Imaging Department, San Paolo Hospital- ASL 2, via Genova 30, Savona, Italy.
| | - P Renzetti
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - L Castellan
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - L Roccatagliata
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy.
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18
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COVID-19 associated mucormycosis: Staging and management recommendations (Report of a multi-disciplinary expert committee). J Oral Biol Craniofac Res 2021; 11:569-580. [PMID: 34395187 PMCID: PMC8354814 DOI: 10.1016/j.jobcr.2021.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 12/26/2022] Open
Abstract
Even before the onslaught of COVID-19 pandemic could settle, the unprecedented rise in cases with COVID-19 associated mucormycosis pushed the medical health to the fringe. Hyperglycaemia and corticosteroids appear to be the most consistent associations leading to the commonest manifestation of mucormycosis, Rhino-Orbito-Cerebral Mucormycosis. To address challenges right from categorisation and staging of the disease to the management of relentless progression, a multi-disciplinary expert committee was formed to handle the task in an evidence-based format to enforce best practices. The report of the committee on one hand attempts to succinctly present the currently available evidence while at the other also attempts to bridge the evidence-deficient gaps with the specialty-specific virtuosity of experts.
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