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Raineau M, Crowe AM, Beccaria K, Luscan R, Simon F, Roux CJ, Ferroni A, Kossorotoff M, Harroche A, Castelle M, Gatbois E, Bourgeois M, Roy M, Blanot S. Pediatric intracranial empyema complicating otogenic and sinogenic infection. Int J Pediatr Otorhinolaryngol 2024; 177:111860. [PMID: 38224655 DOI: 10.1016/j.ijporl.2024.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To describe and compare clinical and microbiological features, surgical and medical management, and outcomes of children with otogenic and sinogenic intracranial empyema (IE) in an institution with an established multidisciplinary protocol. To use the study findings to inform and update the institutional algorithm. METHODS Retrospective analysis was carried out on the electronic healthcare records of all children with oto-sinogenic IE admitted in a 5-year period. RESULTS A total of 76 patients were identified and treated according to an institutional protocol. Two distinct groups were identified: intracranial empyema related to otogenic infection (OI-IE, n = 36) or sinogenic infection (SI-IE, n = 40). SI-IE was seen in older children and had a significantly higher morbidity. Sub-dural IE was seen in a minority (n = 16) and only in SI-IE and required urgent collaborative ENT-neurosurgery. Extra-dural IE occurred more frequently and was seen in both SI-IE and OI-IE. No death and overall low morbidity were observed. Particularities found in SI-IE and OI-IE groups (as thrombosis, microbiology, antibiotic treatment, duration and outcome) permitted the delineation of these groups in our updated algorithm. CONCLUSION The presence of a collaborative multidisciplinary protocol permits the step-wise co-ordination of care for these complex patients in our institution. All patients received prompt imaging, urgent surgical intervention, and antibiotic treatment. Microbiological identification was possible for each patient and antibiotic rationalization was permitted through use of Polymerase chain reaction (PCR) testing in cases of sterile cultures. Of note, intracranial empyema related to sinogenic infection is shown to have significantly more severe clinical presentation, a higher morbidity, and a longer duration of antibiotic therapy than that related to otogenic infection. Study findings allowed for the update and clarification of the institutional protocol, which now clearly demarcates the clinical presentation, biological evidence, radiology, surgical and medical treatments in children with oto-sinogenic IE.
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Affiliation(s)
- Mégane Raineau
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Ann-Marie Crowe
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Romain Luscan
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Francois Simon
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Charles-Joris Roux
- Pediatric Radiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Agnès Ferroni
- Clinical Microbiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Annie Harroche
- Clinical Hematology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Martin Castelle
- Pediatric Immunology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Edith Gatbois
- Hospitalization at Home Department, Assistance Publique des Hôpitaux de Paris, Hôpital Armand Trousseau - Sorbonne Université, Paris, France.
| | - Marie Bourgeois
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Mickaela Roy
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Stéphane Blanot
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
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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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Raho EM, Antonioni A, Cotta Ramusino N, Jubea D, Gragnaniello D, Franceschetti P, Penitenti F, Daniele A, Zatelli MC, Naccarato M, Traluci I, Pugliatti M, Padroni M. Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update. J Pers Med 2023; 13:1557. [PMID: 38003871 PMCID: PMC10672691 DOI: 10.3390/jpm13111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare cause of stroke, particularly in young adults. Several known thrombophilic conditions may lead to an increased CVT risk. Interestingly, few cases in the literature have reported an association between CVT and thyrotoxicosis. Here, we describe the case of a young woman with CVT and concomitant thyrotoxicosis, without any other known prothrombotic conditions. We also performed a literature review of CVT cases and hyperthyroidism, searching for all articles published in peer-reviewed journals. We identified 39 case reports/case series concerning patients with CVT associated with thyrotoxicosis, highlighting, in most cases, the association with additional known prothrombotic factors. We then discussed the possible mechanisms by which hyperthyroidism could underlie a pro-coagulative state resulting in CVT. Thyroid disease might be a more common prothrombotic risk factor than expected in determining CVT. However, in most cases, a coexistence of multiple risk factors was observed, suggesting a multifactorial genesis of the disorder. We hope that this work may alert clinicians to consider thyrotoxicosis as a potential risk factor for CVT, even in patients who apparently have no other pro-coagulative conditions.
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Affiliation(s)
- Emanuela Maria Raho
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Annibale Antonioni
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Niccolò Cotta Ramusino
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Dina Jubea
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Daniela Gragnaniello
- Neurology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Paola Franceschetti
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Francesco Penitenti
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Andrea Daniele
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | | | - Ilaria Traluci
- Neuroradiology Unit, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Maura Pugliatti
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Marina Padroni
- Neurology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
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Yadalla D, Jayagayathri R, Padmanaban K, Ramasamy R, Rammohan R, Nisar SP, Rangarajan V, Menon V. Bacterial orbital cellulitis - A review. Indian J Ophthalmol 2023; 71:2687-2693. [PMID: 37417106 PMCID: PMC10491050 DOI: 10.4103/ijo.ijo_3283_22] [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: 12/17/2022] [Revised: 04/26/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
Infections of orbit and periorbita are frequent, leading to significant morbidity. Orbital cellulitis is more common in children and young adults. At any age, infection from the neighboring ethmoid sinuses is a likely cause and is thought to result from anatomical characteristics like thin medial wall, lack of lymphatics, orbital foramina, and septic thrombophlebitis of the valveless veins between the two. Other causes are trauma, orbital foreign bodies, preexisting dental infections, dental procedures, maxillofacial surgeries, Open Reduction and Internal Fixation (ORIF), and retinal buckling procedures. The septum is a natural barrier to the passage of microorganisms. Orbital infections are caused by Gram-positive, Gram-negative organisms and anaerobes in adults and in children, usually by Staphylococcus aureus or Streptococcus species. Individuals older than 15 years of age are more likely to harbor polymicrobial infections. Signs include diffuse lid edema with or without erythema, chemosis, proptosis, and ophthalmoplegia. It is an ocular emergency requiring admission, intravenous antibiotics, and sometimes surgical intervention. Computed tomography (CT) and magnetic resonance imaging (MRI) are the main modalities to identify the extent, route of spread from adjacent structures, and poor response to intravenous antibiotics and to confirm the presence of complications. If orbital cellulitis is secondary to sinus infection, drainage of pus and establishment of ventilation to the sinus are imperative. Loss of vision can occur due to orbital abscess, cavernous sinus thrombosis, optic neuritis, central retinal artery occlusion, and exposure keratopathy, and possible systemic sequelae include meningitis, intracranial abscess, osteomyelitis, and death. The article was written by authors after a thorough literature search in the PubMed-indexed journals.
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Affiliation(s)
- Dayakar Yadalla
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Pondicherry, India
| | | | | | - Rajkumar Ramasamy
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Ram Rammohan
- Department of Microbiologist, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Sonam Poonam Nisar
- Department of Orbit, Oculoplasty, Aesthetic and Reconstructive Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Viji Rangarajan
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Vikas Menon
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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Podduturi V, Guileyardo JM. Methamphetamine Injection Into Face Causing Fatal Cavernous Sinus Thrombosis. Am J Forensic Med Pathol 2022; 43:256-258. [PMID: 35249989 DOI: 10.1097/paf.0000000000000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cavernous sinus thrombosis is a rare and often fatal condition, usually associated with infections in the head and neck region. Clinical presentation includes fever, headache, and periorbital swelling. Mortality can be high; however, prompt treatment can reduce the probability of death. We present a case of a cavernous sinus thrombosis associated with methamphetamine injection into the face.
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Affiliation(s)
- Varsha Podduturi
- From the Department of Pathology, Harris County Institute of Forensic Sciences
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Magnetic Resonance Images, Pathological Features of Thrombus, and Expression of NLRP Inflammasome in Patients with Acute Ischemic Stroke. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3464042. [PMID: 36072631 PMCID: PMC9398830 DOI: 10.1155/2022/3464042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate imaging features of magnetic resonance imaging (MRI), pathological features of thrombus, and expression of nucleotide-binding oligomerization domain-like receptors protein 3 (NLRP3) inflammasome in acute ischemic stroke (AIS). Their relationship with the prognosis of patients was also explored. Sixty patients with AIS admitted to the hospital were selected as the observation group, and 20 healthy objects were in the control group. The shape of the thrombus was observed by MRI, pathological features of the thrombus were observed under hematoxylin-eosin (HE) staining, and the levels of NLRP3 inflammasome and inflammatory factors in serum were detected. The MRI-T2 weighted imaging (T2WI) signal ratio and plaque enhancement rate in the observation group were higher than those in the control group significantly (P < 0.05). In the observation group, the red/mixed thrombus in 6–12 h and 24 h were also much higher than that in 6 h (P < 0.05). The levels of NLRP3, interleukin-1β (IL-1β), interleukin-18 (IL-18), and tumor necrosis factor-α (TNF-α) in the observation group were higher than those in the control group in 6 h, 6–12 h, and 24 h (P < 0.05), and those reached the highest levels in 24 h. The ratio of fibrins/platelets in the cardiogenic thrombus reached (63.8 ± 15.6) %, which was significantly higher than that in the large-artery atherosclerotic thrombus (49.5 ± 14.2) %, P < 0.05. The ratio of red blood cells (RBCs) in the large atherosclerotic thrombus was (30.7 ± 14.3) %, considerably lower than (42.9 ± 15.2) %, P < 0.05. The prognosis of patients with the fibrin/platelet-rich thrombus was highly lower than that with the RBC-rich thrombus (P < 0.05). The levels with poor prognosis were higher than those with good prognosis (P < 0.05). MRI could be used to assist in the assessment of brain conditions in patients with AIS. NLRP3 inflammasome was involved in the inflammatory response of AIS and can be used for predicting the poor prognosis, having a certain clinical application value. In addition, different types of thrombi also laid a certain impact on prognosis.
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7
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Karakas C, Hajiyev Y, Skrehot HC, Kralik SF, Lambert EM, Pehlivan D. Clinical Profile and Long-Term Outcomes in Pediatric Cavernous Sinus Thrombosis. Pediatr Neurol 2022; 130:28-40. [PMID: 35306302 DOI: 10.1016/j.pediatrneurol.2022.02.006] [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: 09/10/2021] [Revised: 12/23/2021] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric cavernous sinus thrombosis (CST) is a rare condition with limited data regarding its clinical characteristics and long-term outcomes. The objective of this study was to describe the clinical and radiologic features, diagnostic evaluation, management, and long-term prognosis and to identify clinical variables associated with long-term outcomes in pediatric CST. METHODS A retrospective chart review of patients younger than 18 years diagnosed with a CST between 2004 and 2018 at a single center was conducted. RESULTS We identified 16 (M:F = 10:6) children with CST with a mean age of 7.6 years (10 days to 15 years) and average follow-up duration of 29 months (3 weeks to 144 months). The most common symptom and examination finding at presentation was eyelid swelling (n = 8). Six patients had bilateral CST. The most common etiologies were sinusitis (n = 5) and orbital cellulitis (n = 5). Treatments included antibiotics (n = 14), anticoagulation (n = 11), and surgery (n = 5). Only one patient died due to intracranial complications. Twelve patients had a normal examination at follow-up. None of the clinical variables including age (P = 0.14), gender (P = 0.09), use of antibiotics (P = 1.00) or anticoagulation (P = 1.00), surgery (P = 0.28), parenchymal abnormalities (P = 0.30), additional cerebral venous thrombosis (P = 0.28), and early versus late commencing of anticoagulation (P = 1.00) were significant when comparing patients with full/partial resolution versus those with no resolution of thrombosis on follow-up neuroimaging. CONCLUSIONS Our study is one of the largest cohorts with the longest follow-up data for the pediatric CST. Most of our patients had favorable outcomes at follow-up. We found no statistical difference between clinical variables when comparing patients with full/partial resolution versus those with no resolution of thrombosis on follow-up neuroimaging.
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Affiliation(s)
- Cemal Karakas
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Norton Children's Medical Group, Louisville, Kentucky
| | - Yusif Hajiyev
- Department of Pediatric Otolaryngology, Baylor College of Medicine, Houston, Texas
| | - Henry C Skrehot
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Stephen F Kralik
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Elton M Lambert
- Department of Pediatric Otolaryngology, Baylor College of Medicine, Houston, Texas
| | - Davut Pehlivan
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.
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8
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Beyond Gradenigo syndrome: Facial palsy and cavernous sinus involvement in a young teenage girl. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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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Davies TC, Alatsatianos A, Nowak M, Fraser L. Bilateral cavernous sinus thrombosis complicating acute unilateral pansinusitis in a 15-year-old boy. BMJ Case Rep 2020; 13:13/12/e237758. [PMID: 33370987 PMCID: PMC7757505 DOI: 10.1136/bcr-2020-237758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cavernous sinus thrombosis (CST) is a rare and potentially fatal complication of acute sinusitis. Timely diagnosis and management is, therefore, essential in preventing death and neurological disability. Here, we describe the case of a paediatric patient with bilateral CST secondary to acute unilateral pansinusitis that presented with rapidly progressing bilateral periorbital oedema. Initial imaging was negative. This case serves to emphasise the importance of maintaining a high index of suspicion when managing paediatric patients with suspected CST with persistent symptoms. Expeditious investigation and management of our patient in this case resulted in a positive outcome, with resolution of symptoms and no residual neurological deficit.
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Affiliation(s)
| | | | | | - Lyndsay Fraser
- Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
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Rahimizadeh A, Williamson W, Rahimizadeh S, Asgari N. Septic cavernous sinus thrombosis secondary to halo vest pin site infection. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2020; 4:100036. [PMID: 35141604 PMCID: PMC8820062 DOI: 10.1016/j.xnsj.2020.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/31/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
Cavernous sinus thrombosis is a potentially fatal scenario that should be added to the sequels of neglected halo pin site infection. Diagnosis of septic CST requires a high degree of clinical suspicion. Painful proptosis after an infection at the territory of the face is Septic CST unless proven otherwise. Institution of timely and aggressive treatments is required to prevent permanent neurological disability. Recently, for those resistant to medical treatment, endovascular thrombolysis and recanalization have been proposed.
Background Pin site infection is one of the frequent complications of the halo crown application which can be easily handled if addressed early. However, if this issue is neglected then serious infectious events may quickly transpire. Among all of the medical literature that the previously described scenarios have illuminated; we did not encounter a case involving infectious cavernous sinus thrombosis. Case description The authors present a middle age man who arrived at our clinic with an acute left peri-orbital swelling, proptosis, and ophthalmoplegia which had occurred subsequent to an untreated halo pine site infection. With a diagnosis of septic cavernous sinus thrombosis (CST), appropriate antibiotics and anticoagulant therapies were administered. Outcome With the continuation of this conservative treatment regimen, he was successfully managed with no residual neurological consequences. Conclusion Halo vest orthosis is an appropriately tolerated upper cervical spinal stabilizing device that is a commonly used worldwide. Septic CST that is secondary to a halo vest pin site infection has not been previously described within medical literature. In the case of a neglected pin site infection, with demonstration of ipsilateral eyelid edema and proptosis, septic CST should be immediately considered and treated vigorously with antibiotics and anticoagulant therapies.
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12
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Geng B, Wu X, Malhotra A. Septic cavernous sinus thrombosis-Case series and review of the literature. Clin Neurol Neurosurg 2020; 197:106092. [PMID: 32693341 DOI: 10.1016/j.clineuro.2020.106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Septic cavernous sinus thrombosis (CST) is a rare, life-threatening disease with infectious thrombosis causing associated complications resulting in high morbidity and mortality. We report a series of CST patients with assessment of arterial and intracranial complications. METHODS We used the radiology database from a large, academic tertiary care center to collect all patients treated with CST between 2002 and 2019. Patient demographics, source of infection, treatment course and outcomes were evaluated. A review of the recent literature was also performed for similar reported complications from CST. RESULTS 14 patients with CST treated during this time period were assessed. Of the 14 patients, 1 patient died. 7 patients had unilateral narrowing of ICA while 3 patients had bilateral narrowing. The ICA narrowing was reversible in 10/12 patients and improvement but persistent narrowing in one patient. One patient had an infectious pseudo aneurysm that was treated by coiling. Extension of thrombosis to the transverse- sigmoid sinuses and internal jugular vein were seen in 3 patients. Three patients had subdural empyema which was treated surgically. CONCLUSION The prognosis of CST has improved with advancement in treatment, but complications are not infrequent.
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Affiliation(s)
- Bertie Geng
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, United States.
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, United States.
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042, United States.
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13
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Geng B, Wu X, Malhotra A. Lateral rectus atrophy in cavernous sinus thrombosis. Clin Neuroradiol 2018; 29:371-374. [PMID: 30341446 DOI: 10.1007/s00062-018-0729-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 09/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Xiao Wu
- Yale School of Medicine, New Haven, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, Box 208042, CT 06520-8042, New Haven, USA.
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Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review. Eur Arch Otorhinolaryngol 2018; 275:2387-2395. [PMID: 29998385 PMCID: PMC6096574 DOI: 10.1007/s00405-018-5062-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
Purpose Septic cavernous sinus thrombosis (CST) is a rare complication of infections in the head and neck area. CST is notorious for its bad prognosis, with high mortality and morbidity rates described in literature. However, these rates are based on old series. We question whether the prognosis of CST is currently still as devastating. The primary purpose of this study is to assess the mortality and morbidity of CST. Methods Using the databases of all relevant specialties in our tertiary referral hospital, we collected all the patients treated for CST in the period 2005–2017. In addition, a PubMed search, using the mesh term ‘cavernous sinus thrombosis’, was performed. Results We found 12 patients with CST in the study period. Of the 12 patients, 11 survived and 9 recovered without any permanent deficits. Seven patients were treated with anticoagulation, and in none of the patients we saw hemorrhagic complications. In literature, older articles describe higher mortality rates (14–80%), but more recent articles report mortality and morbidity rates similar to our results. Conclusions The prognosis of CST nowadays is more favorable than previously described. Anticoagulation seems to be a safe addition to antibiotic and surgical treatment, at least in patients without central nervous system infection.
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Management of pediatric orbital cellulitis: A systematic review. Int J Pediatr Otorhinolaryngol 2018; 110:123-129. [PMID: 29859573 DOI: 10.1016/j.ijporl.2018.05.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/29/2018] [Accepted: 05/03/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Orbital complications account for 74-85% of all complications from acute sinusitis, more often affect the pediatric population, and can result in devastating consequences. Therefore these patients require prompt diagnosis and proper management. We review and summarize the current literature to determine the appropriate management of each stage of pediatric orbital cellulitis and offer a new comprehensive literature-based algorithm. METHODS Data sources were PubMed/MEDLINE, and Google Scholar. Studies relevant to the management of each subcategory of the Chandler criteria in the pediatric population, limited to the period 1997 through Jan 2018, were compiled and interpreted. Seventy-one studies were reviewed in total. RESULTS Pre-septal and post-septal cellulitis can generally be managed non-surgically, while orbital abscess and cavernous sinus thrombosis are managed surgically. For subperiosteal abscess, non-surgical medical management has been successful in certain patients. Results of the literature review were summarized, and subsequently developed into a comprehensive algorithm for management, including criteria for age, location, and volume of abscess on imaging. CONCLUSIONS Orbital cellulitis, particularly subperiosteal abscesses, in children is not an absolute indication for immediate surgical intervention. Conservative measures can be safe and effective if appropriately used, depending on patient characteristics, clinical course, and imaging.
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Orbital cellulitis. Surv Ophthalmol 2018; 63:534-553. [DOI: 10.1016/j.survophthal.2017.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/12/2022]
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Hudgins PA, Baugnon KL. Head and Neck: Skull Base Imaging. Neurosurgery 2017; 82:255-267. [DOI: 10.1093/neuros/nyx492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 09/07/2017] [Indexed: 12/20/2022] Open
Abstract
Abstract
There are a myriad of head and neck pathologies that extend from the extracranial to the intracranial compartment, traversing the skull base, and knowledge of the imaging appearance of this pathology is critical to practicing neurosurgeons. This article reviews some of the important inflammatory or acquired head and neck pathology along the skull base, neoplastic skull base lesions, and the intracranial extension of head and neck malignancy. Focus will be on the relevant anatomy, appropriate imaging protocols to evaluate these processes, as well as the differentiating imaging findings on computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Patricia A Hudgins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Berest IE, Mironets SN. [Septic thrombus of the cavernous sinus]. Vestn Otorinolaringol 2017; 82:72-76. [PMID: 29260788 DOI: 10.17116/otorino201782672-76] [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: 06/07/2023]
Abstract
The present review was designed to represent modern views of the problem of etiopathogenesis, clinical features, diagnostics, and treatment of septic thrombus of the cavernous sinus with special reference to the currently available methods for the detection and management of this condition.
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Affiliation(s)
- I E Berest
- Saint Luke Lugansk State Medical University, Lugansk, Lugansk People's Republic, 91045
| | - S N Mironets
- Saint Luke Lugansk State Medical University, Lugansk, Lugansk People's Republic, 91045
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Abstract
Investigators from the Children’s Hospital of Philadelphia analyzed the clinical and radiographic findings in 12 cases of cavernous sinus thrombosis (CST) seen between 2000 and 2013, and conducted a literature search and review of the pooled data.
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Affiliation(s)
- Rochelle Sweis
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
| | - José Biller
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
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Lall NU, Stence NV, Mirsky DM. Magnetic Resonance Imaging of Pediatric Neurologic Emergencies. Top Magn Reson Imaging 2015; 24:291-307. [PMID: 26636636 DOI: 10.1097/rmr.0000000000000068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although computed tomography is often the first line of imaging in the emergency setting, magnetic resonance imaging (MRI) is of increasing importance in the evaluation of central nervous system emergencies in the pediatric population. As such, it is necessary to understand the indications for which MRI may be necessary. This article reviews the unique pathophysiologic entities affecting the pediatric population and the associated MRI findings. Specifically, utility of emergent MRI and characteristic appearances of traumatic brain injury, traumatic spinal injury, nonaccidental trauma, arterial ischemic stroke, cerebral sinovenous thrombosis, stroke mimics, and central nervous system infections are described.
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Affiliation(s)
- Neil U Lall
- *Cincinnati Children's Hospital Medical Center, Cincinnati, OH †Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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