[A case of Takayasu arteritis complicated with cavernous sinus syndrome presenting as unilateral optic nerve DWI hyperintensity]

A 47-year-old male patient with a history of Takayasu arteritis presented with prominent symptoms of left eyeball fixation, protrusion, and visual loss. Orbital magnetic resonance imaging revealed hyperintensity on diffusion-weighted imaging of the left optic nerve, with corresponding low signal on apparent diffusion coefficient maps, suggestive of acute infarction of the left optic nerve. Combined with the patient's cranial magnetic resonance imaging findings, the diagnosis of cavernous sinus syndrome was established.

Traumatic cavernous sinus syndrome - A peculiar presentation of multiple cranial nerve neuropathies following a minor head injury: Case report and literature review

BACKGROUND

In patients with traumatic head injuries, the percentage of cranial nerve injuries (CNI) range from4.3 to 17.6% in which majority are isolated CNI[1-5].In present literature, moderate to severe types of head injuries are often studied which may result in a lack of representation and description of CNI associated with minor head injuries (MHI). Alongside this peculiar case of a traumatic cavernous sinus syndrome (CSS) that is non-thrombotic and non-fistulous in nature, this paper aims to analyse traumatic CNI in non-severe head injuries and the surrounding literature.

CASE REPORT

A 65-year-old man who had sustained a minor head injury was found to have CNI of III, IV and VI.Brain imaging showed scattered traumatic subarachnoid haemorrhage and a non-displaced right zygomatic arch fracture. Despite the short course of high dose dexamethasone, he showed only partial recovery of his CNI after one year.

CONCLUSION

We present a case of traumatic CSS likely secondary to tractional injury from a MHI. Injury to the extraocular nerves wasfound to be one of the more commonly observed combination of CNI from the literature review conducted. In patients with MHI, multiple CNI is less common. Hence, consideration should be given to work upfor secondary causes such as tumours. There is presently no known clear identifiable pattern of CNI associated with MHI. CT brain findings of skull base fractures and early onset of cranial nerve palsies are generally associated with worse outcomes. More remains to be studied about tractional CNI in non-severe head injuries.

Cavernous Sinus Syndrome Caused by Noninvasive Fungal Maxillary Sinusitis

It is rare that cavernous sinus complications are caused by maxillary sinus lesions because the locations of these lesions are some distant from each other. The authors describe an unusual presentation that the primary lesion was located in the maxillary sinus and triggered cavernous sinus syndrome and optic nerve symptoms. The most likely possibility was that the infection traveled retrograde along the vascular plexus. Removal of maxillary sinus lesions and establishment ventilation may achieve source control.

[Flow diverter treatment for dissecting aneurysm causing cavernous sinus syndrome]

A sinus cavernosus szindróma egyoldalú ophthalmoplegia, autonóm diszfunkció és a nervus trigeminus ophthalmicus vagy maxillaris ága szenzoros kiesésének kombinációja. Fejsérülést követően sinus cavernosus szindróma jelentkezése esetén mindenképpen gondoljunk a dissectiós eredetű aneurysma lehetőségére. Vérzett aneurysmák mellett a ’silent’ intracranialis aneurysmákat is kezelnünk kell, ha kompressziós tüneteket okoznak. Esetismertetésünkben egy 23 éves nőbeteg sikeres kezelését mutatjuk be, aki esés során eszméletét vesztette, majd azonnal jobb oldali ptosis, ophthalmoplegia és arc területi érzéskiesés jelentkezett. Az angiográfia a jobb arteria carotis interna sinus cavernosus szakaszán dissectiós aneurysmát igazolt, melyet a sérülést követő 6. napon áramlásmódosító sztenttel kezeltünk. A beavatkozás szövődménymentesen zajlott, gyors és teljes radiológiai és klinikai gyógyulást eredményezett. Esetismertetésünk is megerősíti azt a metaanalíziseken alapuló tényt, hogy az arteria carotis interna sinus cavernosus szakaszán jelentkező dissectiós aneurysma áramlásmódosító sztenttel biztonságosan és sikeresen kezelhető. Ha a kezelés minél korábban elvégezhető, akkor a sinus cavernosus szindróma minden tünete rendeződik, az azonos oldali ophthalmoplegia és az arc érzéskiesése néhány napon belül tökéletesen gyógyulhat. Orv Hetil. 2023; 164(52): 2074–2078.