Early cavernous sinus thrombosis following unilateral pansinusitis in a child

Abstract

Cavernous sinus thrombosis (CST) is a life-threatening entity with a high rate of mortality and lifelong morbidity. A strong clinical suspicion of the complication, early radiological detection and institution of timely, aggressive treatment are required to prevent permanent neurological disability. We present a 12-year-old girl with bilateral CST following unilateral pansinusitis. Clinical symptoms of headache and retro-orbital pain out of proportion to clinical signs on presentation prompted a suspicion of something beyond sinusitis and raised the clinical suspicion of cavernous sinus involvement. In spite of institution of an early medical treatment, she progressed to develop bilateral cranial nerve paresis. However, with the persistence of antibiotics and anticoagulation therapy, she was successfully managed with no residual neurological sequelae. The aim of this presentation is to highlight the grave consequences of cavernous sinus involvement following infections of paranasal sinus and the rare complete recovery from disability in this case.

Cavernous Sinus Thrombosis in Children

“…The most common organism is Staphylococcus aureus (69%), followed by the Streptococccal species (17%), Pneumococcus (5%), gram negative species (5%), Bacteroides (2%), and Fusobacterium (2%). Valveless communications between the facial and ophthalmic veins and the cavernous sinus are responsible for infectious spread between the paranasal sinus and orbit to the cavernous sinus [ 2 ]. CST can also be a complication of otitis media and less often, pharyngitis or dental infection.…”