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Long B, Field SM, Singh M, Koyfman A. High risk and low prevalence diseases: Cavernous sinus thrombosis. Am J Emerg Med 2024; 83:47-53. [PMID: 38959601 DOI: 10.1016/j.ajem.2024.06.024] [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: 05/16/2024] [Revised: 06/07/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Cavernous sinus thrombosis (CST) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of CST, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION CST is a potentially deadly thrombophlebitic disease involving the cavernous sinuses. The most common underlying etiology is sinusitis or other facial infection several days prior to development of CST, though other causes include maxillofacial trauma or surgery, thrombophilia, dehydration, or medications. Staphylococcus aureus, streptococcal species, oral anaerobic species, and gram-negative bacilli are the most frequent bacterial etiologies. The most prevalent presenting signs and symptoms are fever, headache, and ocular manifestations (chemosis, periorbital edema, ptosis, ophthalmoplegia, vision changes). Cranial nerve (CN) VI is the most commonly affected CN, resulting in lateral rectus palsy. Other CNs that may be affected include III, IV, and V. The disease may also affect the pulmonary and central nervous systems. Laboratory testing typically reveals elevated inflammatory markers, and blood cultures are positive in up to 70% of cases. Computed tomography of the head and orbits with intravenous contrast delayed phase imaging is recommended in the ED setting, though magnetic resonance venography demonstrates the highest sensitivity. Management includes resuscitation, antibiotics, and anticoagulation with specialist consultation. CONCLUSION An understanding of CST can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Steven M Field
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Manpreet Singh
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
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2
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Vanegas LCR, Urrea AR, Torres JMC, Agudelo LG, Curcho LCA. Septic embolism due to periorbital cellulitis caused by pimple drainage. Dermatol Reports 2024; 16:9779. [PMID: 38957625 PMCID: PMC11216132 DOI: 10.4081/dr.2023.9779] [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: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/04/2024] Open
Abstract
Everyone has used homemade pimple drainage at some point in their lives, particularly in their adolescent and early adult years. However, pimple drainage should always be considered a mild medical procedure, especially in cases where the patient has serious skin diseases. We present the case of a 22-year-old female patient who, in the course of her routine, made a home pimple drainage that resulted in periorbital cellulitis and a septic embolism, despite the fact that these types of clinical cases are uncommon in routine medical practice. This case emphasizes how crucial it is to identify periorbital cellulitis early and treat it appropriately in order to stop a septic embolism from developing.
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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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Ooi SY, Tan TS, Teo HE. Bilateral septic cavernous sinus thromboses: an uncommon complication of paranasal and orbital infection. Br J Hosp Med (Lond) 2024; 85:1-2. [PMID: 38300680 DOI: 10.12968/hmed.2023.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Shin Yin Ooi
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Timothy Se Tan
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Harvey Elj Teo
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
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Vloka C, Perera C, Ng J. Non-visual complications of orbital cellulitis (NVCOC) in pediatric vs adult populations. Orbit 2023; 42:587-591. [PMID: 36530041 DOI: 10.1080/01676830.2022.2155196] [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: 10/16/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE There have been many publications evaluating the visual outcomes of patients treated for orbital cellulitis. The aim of this study was to evaluate non-visual complications of post-septal orbital cellulitis (NVCOC) present 30 days after discharge from index hospitalization. METHODS This was an IRB-approved, retrospective chart review. RESULTS Ninety patients (45 pediatric, 45 adults) were identified with OC. NVCOC were significantly more common in adult patients as compared to children (40.0% vs 15.6% respectively; p < 0.05). The most common NVCOC among children was persistent ptosis, while clinically significant scarring was most common in adults. NVCOC were less persistent in children as compared to adults with 71.4% of complications in children resolving spontaneously by 6 month follow up as compared to 11.1% adults. (p < 0.05). The only statistically significant risk factor identified for the development of NVCOC in children and adults was the presence of ICE (intracranial extension) during index hospitalization (p < 0.05) and the presence of an infected orbital implant (p < 0.05) respectively. CONCLUSIONS Adult patients experience NVCOC complications more often than children. Furthermore, the nonvisual complications in children are more likely to resolve spontaneously than those in adults. The intracranial spread of infection is a significant risk factor for late complications in children. The presence of an orbital wall/floor implant is a significant risk factor for late complications in adults. There are many differences in the etiology, pathophysiology, and course of NVCOC in children and adults, so information on these two populations should be reported separately.
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Affiliation(s)
- Caroline Vloka
- Department of Ophthalmology, Colorado University, Aurora, Colorado, USA
| | - Chandrashan Perera
- Department of Ophthalmic AI Research, Stanford University, Palo Alto, California, USA
| | - John Ng
- Department of Ophthalmology, Casey Eye Institute, Portland, Oregon, USA
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6
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Ang T, Cameron C, Tong JY, Wilcsek G, Tan J, Patel S, Selva D. Methicillin-resistant Staphylococcus aureus-associated orbital cellulitis: a case series. Int Ophthalmol 2023; 43:2925-2933. [PMID: 37029211 PMCID: PMC10371901 DOI: 10.1007/s10792-023-02698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE In recent years, methicillin-resistant Staphylococcus aureus (MRSA) orbital cellulitis (OC) has drawn increasing clinical and public health concern. We present a case series of MRSA OC encountered at four Australian tertiary institutions. METHODS A multi-centre retrospective case series investigating MRSA OC in Australia from 2013 to 2022. Patients of all ages were included. RESULTS Nine cases of culture-positive non-multi-resistant MRSA (nmMRSA) OC were identified at four tertiary institutions across Australia (7 male, 2 female). Mean age was 17.1 ± 16.7 years (range 13-days to 53-years), of which one was 13 days old, and all were immunocompetent. Eight (88.9%) patients had paranasal sinus disease, and seven (77.8%) had a subperiosteal abscess. Four (44.4%) had intracranial extension, including one (11.1%) case which was also complicated by superior sagittal sinus thrombosis. Empirical antibiotics, such as intravenous (IV) cefotaxime alone or IV ceftriaxone and flucloxacillin, were commenced. Following identification of nmMRSA, targeted therapy consisting of vancomycin and/or clindamycin was added. Nine (100%) patients underwent surgical intervention. Average hospital admission was 13.7 ± 6.9 days (range 3-25 days), with two patients requiring intensive care unit (ICU) admission due to complications related to their orbital infection. All patients had favourable prognosis, with preserved visual acuity and extraocular movements, following an average follow-up period of 4.6 months (range 2-9 months). CONCLUSION NMMRSA OC can follow an aggressive clinical course causing severe orbital and intracranial complications across a wide demographic. However, early recognition, initiation of targeted antibiotics and surgical intervention when required can effectively manage these complications and achieve favourable visual outcomes.
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Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Cassie Cameron
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Jessica Y Tong
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Geoff Wilcsek
- Department of Ophthalmology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jeremy Tan
- Department of Ophthalmology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dinesh Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
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Alfaheed M, Campos S, Gupta J, Fayyaz J, Litwin S. Stick a Needle in My Eye: A Case Report of Penetrating Needlefish Injury Causing Cavernous Sinus Thrombosis and Carotid Cavernous Fistula. Cureus 2023; 15:e34453. [PMID: 36874751 PMCID: PMC9981213 DOI: 10.7759/cureus.34453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
While swimming in the ocean on vacation in Cuba, a previously healthy 17-year-old female was unexpectedly stabbed through her orbit and into her brain by a needlefish. This is a unique case of a penetrating injury causing orbital cellulitis, retro-orbital abscess, cerebral venous sinus thrombosis and carotid cavernous fistula. After initial management at a local emergency department, she was transferred to a tertiary care trauma centre where she was treated by a team of emergency, neurosurgery, stroke neurology, ophthalmology, neuroradiology and infectious disease physicians. The patient faced a significant risk of a thrombotic event. There was careful consideration from the multidisciplinary team about the utility of thrombolysis or an interventional neuroradiology procedure. Ultimately, the patient was treated conservatively with intravenous antibiotics, low molecular weight heparin and observation. The patient continued to show clinical improvement several months later, which supported the challenging decision to opt for conservative management. There are very few cases to guide the treatment of this type of contaminated penetrating orbital and brain injury.
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Affiliation(s)
| | - Sarah Campos
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN
| | - Joel Gupta
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN
| | - Jabeen Fayyaz
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN.,Faculty of Medicine, University of Toronto, Toronto, CAN
| | - Sasha Litwin
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN.,Faculty of Medicine, University of Toronto, Toronto, CAN
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Abu-Rmaileh M, Smith ES, Edgar-Zarate C. Rapid Facial Swelling in a 15-Year-Old Female. Clin Pediatr (Phila) 2022; 61:573-577. [PMID: 35510350 DOI: 10.1177/00099228221091431] [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: 11/15/2022]
Affiliation(s)
- Muhammad Abu-Rmaileh
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Emily S Smith
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR, USA
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9
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Swiatek K, Peterson E, Gupta L, Timoney P. Pediatric cavernous sinus and superior ophthalmic vein thrombophlebitis complicated by peri-venous orbital abscesses. Am J Ophthalmol Case Rep 2022; 27:101640. [PMID: 35813589 PMCID: PMC9263864 DOI: 10.1016/j.ajoc.2022.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This case report documents a 13-year-old male with bilateral cavernous sinus thrombosis and left superior ophthalmic vein thrombosis secondary to sphenoid sinusitis who subsequently developed peri-venous orbital abscesses. Observations Although the patient initially improved clinically with intravenous antibiotic therapy and therapeutic anticoagulation, his symptoms returned and repeat imaging demonstrated two well-circumscribed, rim-enhancing lesions in the left orbit concerning for abscesses. Surgical intervention revealed that these purulent collections were contiguous with the superior and inferior ophthalmic veins with the superior collection also containing hemorrhagic material. Despite aggressive management, the abscess in the inferolateral orbit recurred, requiring repeat surgical intervention. The patient was ultimately discharged on parenteral antibiotics and anticoagulation, and on outpatient follow-up, there was no evidence of recurrence. Conclusions and Importance This case report describes a pediatric patient with bilateral cavernous sinus thrombosis who developed the rare complication of multiple peri-venous orbital abscesses despite appropriate treatment with antibiotics. The patient's complex clinical course highlights the importance of prompt repeat imaging and possible surgical intervention upon clinical changes, especially in patients with infections from the Streptococcus milleri group.
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Affiliation(s)
- Kayla Swiatek
- University of Kentucky, College of Medicine 800 Rose Street, MN 150, Lexington, KY, 40506, USA
| | - Eric Peterson
- University of Kentucky, Department of Ophthalmology, 110 Conn Terrace, Lexington, KY, 40508, USA
| | - Lalita Gupta
- University of Kentucky, Department of Ophthalmology, 110 Conn Terrace, Lexington, KY, 40508, USA
| | - Peter Timoney
- University of Kentucky, Department of Ophthalmology, 110 Conn Terrace, Lexington, KY, 40508, USA
- Corresponding author. University of Kentucky Advanced Eye Care, 110 Conn Terrace, Lexington, KY, 40508, USA.
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10
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Pilarczyk-Zurek M, Sitkiewicz I, Koziel J. The Clinical View on Streptococcus anginosus Group – Opportunistic Pathogens Coming Out of Hiding. Front Microbiol 2022; 13:956677. [PMID: 35898914 PMCID: PMC9309248 DOI: 10.3389/fmicb.2022.956677] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Three distinct streptococcal species: Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus, belonging to the Streptococcus anginosus group (SAG), also known as Streptococcus milleri group, have been attracting clinicians and microbiologists, not only as oral commensals but also as opportunistic pathogens. For years they have been simply classified as so called viridans streptococci, and distinct species were not associated with particular clinical manifestations. Therefore, description of SAG members are clearly underrepresented in the literature, compared to other medically relevant streptococci. However, the increasing number of reports of life-threatening infections caused by SAG indicates their emerging pathogenicity. The improved clinical data generated with the application of modern molecular diagnostic techniques allow for precise identification of individual species belonging to SAG. This review summarizes clinical reports on SAG infections and systematizes data on the occurrence of individual species at the site of infection. We also discuss the issue of proper microbiological diagnostics, which is crucial for further clinical treatment.
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Affiliation(s)
- Magdalena Pilarczyk-Zurek
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Izabela Sitkiewicz
- Center for Translational Medicine, Warsaw University of Life Sciences (SGGW), Warszawa, Poland
| | - Joanna Koziel
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
- *Correspondence: Joanna Koziel,
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11
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Kim JS, Yang JW, Kim YJ. Septic Cavernous Sinus Thrombosis Caused by Dental Infection. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.5.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We report a case of bilateral septic cavernous thrombosis caused by a dental infection.Case summary: A 58-year-old male was transferred to our hospital because of left-sided proptosis and eyelid swelling. The patient had fever and left temporal headache, which did not respond to oral and intravenous antibiotics. After experiencing a tooth injury while chewing hard food 3 months ago, the patient developed toothache and swelling around the tooth for which he did not take any treatment. The patient had left eyelid edema, ptosis, chemosis, and conjunctival congestion. The left eye movements were limited in all directions. Brain magnetic resonance imaging showed dilatation and thrombosis of the left superior ophthalmic vein and thrombosis of bilateral cavernous sinuses. The patient was treated with systemic antibiotics and anticoagulants. The blood culture showed growth of Parvimonas micra and Dialister Pneumosintes, which are common causes of dental infection.Conclusions: Septic thrombosis of the cavernous sinus and superior ophthalmic vein thrombophlebitis can occur due to the spread of dental infection. Prompt diagnosis and treatment are important for rapid resolution of symptoms and good prognosis.
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12
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Lawrence AS, Stoddard DG, Czyz CN, Richardson TE, Michels KS. Orbital cellulitis and cavernous sinus thrombosis with contralateral sinus disease in a COVID-19 positive adolescent patient. Orbit 2021; 42:332-335. [PMID: 34847834 DOI: 10.1080/01676830.2021.2006722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with COVID-19 have been reported to have elevated coagulation factors, which is a well-documented cause of venous thromboembolism events such as deep vein thrombosis and pulmonary embolism. Other venous thrombotic events, however, such as cavernous sinus thrombosis (CST) have been less commonly observed, specifically in combination with primary orbital cellulitis. Due to its unique anatomic location, the cavernous sinus is susceptible to thrombophlebitis processes including septic thrombosis and thrombosis most commonly from sinusitis. Many studies have shown that in the antibiotic era thromboembolic events of the cavernous sinus are less common due to infection spread from the orbit or facial region. This case report describes a 17-year-old COVID-19 positive male who presented with a left-sided primary orbital cellulitis with CST without radiographic evidence of ipsilateral sinus disease.
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Affiliation(s)
- Amelia S Lawrence
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - David G Stoddard
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA.,Department of Otorhinolaryngology, Columbia Surgical Specialists, Spokane, Washington, USA
| | - Craig N Czyz
- Section Oculofacial Plastic & Reconstructive Surgery, Ohio University/Ohio Health, Columbus, Ohio, USA
| | - Thomas E Richardson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Kevin S Michels
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA.,Department of Ophthalmology, Northwest Eyelid and Orbital Specialists, PS, Spokane, Washington, USA
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13
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Bobker SM, Safdieh JE. Approach to Headache. Semin Neurol 2021; 41:633-643. [PMID: 34826868 DOI: 10.1055/s-0041-1726360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a very high prevalence of headache in both outpatient and inpatient settings, in the United States and worldwide, due to an abundance of possible causes. Having a practical and systematic approach to evaluating and treating headache is, therefore, key to making the correct diagnosis, or possibly overlapping diagnoses. Taking a thorough and methodical headache history is the mainstay for diagnosis of both primary and secondary headache disorders. Evaluation and workup should include a complete neurological examination, consideration of neuroimaging in specific limited situations, and serum or spinal fluid analysis if indicated. Adopting a diagnostic approach to headache ensures that cannot-miss, or potentially fatal, headache syndromes are not overlooked, while resource-intensive tests are performed only on an as-needed basis.
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Affiliation(s)
- Sarah M Bobker
- Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Joseph E Safdieh
- Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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14
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Ali S. Cavernous Sinus Thrombosis: Efficiently Recognizing and Treating a Life-Threatening Condition. Cureus 2021; 13:e17339. [PMID: 34567880 PMCID: PMC8451531 DOI: 10.7759/cureus.17339] [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] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Cavernous sinus thrombosis (CST) can develop as a result of both infectious and noninfectious conditions. Infections in the middle part of the face caused by Staphylococcus aureus are the most common cause of septic thrombosis of the cavernous sinuses. Paranasal (typically sphenoid) sinusitis, dental abscess, and, less commonly, otitis media are other antecedent sources of infection. Fever is almost always present, but a headache may not be noticeable. In almost all cases, periorbital edema, chemosis, proptosis, and a restriction of extraocular movements (particularly lateral gazing) emerge. Within two days of the development of unilateral symptoms, involvement of the opposite eye is common. Although CT can be useful, MRI is likely to be the preferred diagnostic method. Antibiotics and occasionally surgical drainage of the infection's primary focus are used to treat it. Complete recovery is about 50% while the death rate is around 30%.
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Affiliation(s)
- Selma Ali
- Department of Family Medicine, Premier Family Medicine, Denver, USA.,Department of Emergency Medicine, National Ribat University, Khartoum, SDN
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15
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Qu H, Li Y, Chen M, Sun H, Du S, Cheng Y, Zhan S. Cavernous sinus thrombosis: An insidious and dangerous "do-not-miss" diagnosis. Headache 2021; 61:1144-1149. [PMID: 34325491 DOI: 10.1111/head.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Huiyang Qu
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanling Li
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengying Chen
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Honghong Sun
- Department of Radiology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuang Du
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuxuan Cheng
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuqin Zhan
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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16
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Khan SA, Hussain A, Phelps PO. Current clinical diagnosis and management of orbital cellulitis. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1941876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sara A. Khan
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ahsen Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul O. Phelps
- Department of Surgery, NorthShore University Health System, Glenview, IL, USA
- Department of Ophthalmology and Visual Science, University of Chicago Pritzker College of Medicine, Chicago, IL, USA
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17
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Leal SM, Rodino KG, Fowler WC, Gilligan PH. Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 PMCID: PMC8262805 DOI: 10.1128/cmr.00070-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
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Affiliation(s)
- Sixto M. Leal
- Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyle G. Rodino
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - W. Craig Fowler
- Department of Surgery, Campbell University School of Medicine, Lillington, North Carolina, USA
| | - Peter H. Gilligan
- Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Imaging of orbital infectious and inflammatory disease in children. Pediatr Radiol 2021; 51:1149-1161. [PMID: 33978792 DOI: 10.1007/s00247-020-04745-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 10/21/2022]
Abstract
Most acute nontraumatic periorbital and intraorbital pathologies in pediatric patients have an underlying infectious or inflammatory etiology, and imaging frequently plays a key role in the workup and management of these children. In this paper we review the clinical presentation and imaging findings in children with some of the most common infectious and inflammatory diseases involving the orbit. Basic relevant anatomy and imaging findings on various imaging modalities are also reviewed.
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Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: A review. Surv Ophthalmol 2021; 66:1021-1030. [PMID: 33831391 DOI: 10.1016/j.survophthal.2021.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
Septic cavernous sinus thrombosis (SCST) is a rare, yet severe, process typically arising from infections of the paranasal sinuses (predominately ethmoid and/or sphenoid sinusitis) and less commonly, otogenic, odontogenic, and pharyngeal sources. Clinical symptoms of SCST arise from obstruction of venous drainage from the orbit and compression of the cranial nerves within the cavernous sinus. In the preantibiotic era SCST was considered universally fatal (80-100%); however, with the introduction of antibiotics the overall incidence, morbidity, and mortality of SCST have greatly declined. In spite of dramatic improvements, morbidity and mortality remain high, with the majority of patients experiencing neurological sequalae, highlighting the severity of the disease and the need for prompt recognition, diagnosis, and treatment. Here we review of the literature on SCST with a focus on the current recommendations and recent evidence for diagnostic and medical management of this condition.
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Affiliation(s)
- Jonathan T Caranfa
- Department of Ophthalmology, New England Eye Center Tufts University School of Medicine, Boston, Massachusetts, USA; Eastern Connecticut Health Network, Manchester Memorial Hospital, Manchester, Connecticut, USA.
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Dan TF, Jianu SN, Iacob N, Motoc AGM, Munteanu G, Băloi A, Albulescu N, Jianu DC. Management of an old woman with cavernous sinus thrombosis with two different mechanisms: case report and review of the literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:1329-1334. [PMID: 34171082 PMCID: PMC8343534 DOI: 10.47162/rjme.61.4.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022]
Abstract
Cavernous sinus thrombosis (CST) usually produces a characteristic clinical syndrome. Septic CST represents a sporadic, but severe complication of infection of the cavernous sinuses, which can bring high mortality and morbidity rates if not treated right away. Case presentation: The current research is a case report of a 64-year-old woman with inherited thrombophilia who developed an acute mastoid infection that resulted in septic right CST. The clinical diagnosis was verified by laboratory studies and evidence from high-resolution computed tomography (HRCT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Clinical medical care resulted in the patient being successfully treated with low-molecular-weight heparin and broad-spectrum intravenous antibiotics, which avoided severe complications.
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Affiliation(s)
- Traian Flavius Dan
- Department of Neurology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Silviana Nina Jianu
- Department of Ophthalmology, Dr. Victor Popescu Military Emergency Hospital, Timişoara, Romania
| | - Nicoleta Iacob
- Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Neuromed Diagnostic Imaging Centre, Timişoara, Romania
| | - Andrei Gheorghe Marius Motoc
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- Department of Anatomy and Embryology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Georgiana Munteanu
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Adelina Băloi
- Department of Anesthesia and Intensive Care, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Nicolae Albulescu
- Department of Cardiology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Dragoş Cătălin Jianu
- Department of Neurology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
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Shen MF, Chen HJ. Unilateral proptosis in Lemierre's syndrome variant. Thorax 2020; 75:815-816. [PMID: 32546572 DOI: 10.1136/thoraxjnl-2020-214748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/21/2020] [Accepted: 05/02/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Meng-Fang Shen
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Jen Chen
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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