Cavernous Sinus Thrombosis in Children

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.

Cavernous sinus thrombosis in a 14-year old boy

“…The patient presented in the case report had non-specific headache without any localizing signs for over three months; same presentation has been noted previously in paranasal sinus disease especially with sphenoid sinus involvement, whereby patients were diagnosed after development of complications. 19,20 Contrast-enhanced CT scan is useful in determining the cause of CST 3,4,6,15,21 as it happened in this case report where it was revealed that patient had pansinusitis. On the other hand, the fact that CT scan was done after the patient had been on anticoagulation for past few days might have contributed to lesser radiological findings; likewise, contrasted CT scan and MRI may be normal; in such cases; High Resolution CT scan and MRI are more sensitive 4,22 , however the two diagnostic investigations are not available at our facility.…”

“…Anaerobic bacteria should always be considered if the disease process continues despite antibiotics covering for grampositive organisms. 2,20,21,23 Due to the severity of disease at presentation and the fact that we have not documented cases of CST in our setting, this being the first reported case; we decided to cover the patient with vancomycin and metronidazole to cover for possibility of methicillin-resistant Staphylococcus aureus and anaerobes respectively. Antibiotics should be administered for an extended period, at least two weeks beyond the time of clinical resolution, because bacteria sequestered within the thrombus may not be killed until the dural sinuses have started to recanalize.…”

Methamphetamine Injection Into Face Causing Fatal Cavernous Sinus Thrombosis

“…By far, the most common organism associated with CST is S. aureus (69%), followed by Streptococcus species (17%); however, a few cases involve pneumococcal or anaerobic infections. 3 The cavernous sinuses are located above and lateral to the sphenoid sinus, and adjacent to each side of the sella turcica and are spaces formed by dura mater and filled with venous blood. This blood drains from facial veins (via the superior and inferior ophthalmic veins) as well as the sphenoid and middle cerebral veins through a freely anastomosing valveless venous system.…”

“…By far, the most common organism associated with CST is S. aureus (69%), followed by Streptococcus species (17%); however, a few cases involve pneumococcal or anaerobic infections 3 …”

Increased risk of cardiovascular diseases in patients with chronic rhinosinusitis: a longitudinal follow-up study using a national health screening cohort

“…For example, CRS patients experience sleep-disordered breathing, including obstructive sleep apnea, which plays a critical role in developing atherosclerotic conditions (49) . In the case of stroke, infected thrombi or septic emboli originating from a primary infected focus, especially posterior ethmoiditis and sphenoiditis, can lead to stroke because of anatomical characterization in which these sinuses intersect the internal cerebral artery with a 0.1-mm thin bone wall and vessels originating from the internal carotid artery (ICA) system through the anterior and posterior ethmoidal arteries supply the roof of the skull base (50,51) .…”