Cavernous Sinus Thrombosis of Nasal Origin in Children

Abstract

Cavernous sinus thrombosis is a rare presentation. Early diagnosis and aggressive treatment are required to prevent morbidity and mortality. Nasal infections can give rise to serious intracranial complications. Presented here is a case series of cavernous sinus thrombosis of nasal septic origin. The purpose of this article is to report our experience in pediatric patients with this illness to ascertain a clinical course and outcomes for further clinical application. Eight (08) cases of nasalseptic origin of cavernous sinus thrombosis ata tertiary care teaching hospital in the north India region of India were included in the study. Cases presented with various symptoms like headache, proptosis, ophthalmoplegia and fever. The patients were investigated by doing High Resolution Computed Tomography of nose & PNS and brain with intravenous contrast. The cases were treated with intravenous broad spectrum antibiotics. Eight patients less than 16 years of age (mean age of 11.2 years)diagnosed with cavernous sinus thrombophlebitis due to nasal septic focus over the period of 05 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children. A conservative management strategy with antibiotics gave a good prognosis in these cases. There were no deaths. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.

Cavernous Sinus Thrombosis in Children

“…2,3 Infarction was less prevalent than in our cohort, with only 1 child demonstrating infarct. In an adult series, 4 of 7 patients developed neurological impairment, including 1 with vision loss.…”

“…The incidence has likely decreased significantly because of the use of antibiotics. [1][2][3] CST has been reported to cause CAN and vasospasm, 4,5 embolic infarcts, and large territory infarction from hypoperfusion. 4,6 The standard acute treatment for childhood cerebral venous sinus thrombosis is typically anticoagulation therapy (ACT) 7 although the optimal treatment for children with the subset of CST remains largely uncertain.…”

Septic thrombus of the cavernous sinus

“…S. Varshney и соавт. [8] считают, что впервые ТКС как осложнение эпидуральной и субдуральной инфекции описал Bright в 1831 г.…”

“…Антибиотик группы карбапенемов: меропенем 6 г/сут внутривенно [23]. Адекватной антибактериальной терапией при ТКС является комбинация ванкомицина и цефтриаксона/ампициллина-сульбактама/пиперациллина-тазобактама [8,12,23]. Сульбактам и тазобактам -лекарственные средства, подавляющие действие β-лактамазы, используются в комбинации с другими антибиотиками.…”

“…Сульбактам и тазобактам -лекарственные средства, подавляющие действие β-лактамазы, используются в комбинации с другими антибиотиками. Учитывая полимикробную этиологию синусогенных ТКС, необходимо назначать антианаэробные препараты (например, метронидазол) [4,8]. Парентеральное применение антибактериальной терапии длительное -до 3-4 нед [21].…”