Septic Thrombosis of the Cavernous Sinus: Two Different Mechanisms

Pavlovich, Peter; Looi, Audrey; Rootman, Jack

doi:10.1080/01676830500506077

Cited by 55 publications

(37 citation statements)

References 12 publications

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“…The role of anticoagulants is unclear and their effects have not been proved. There are no controlled studies of the use of anticoagulants in treating superior ophthalmic vein thrombosis [4]. The role of anticoagulants as an adjuvant to antibiotic therapy remains controversial, as the risk of intracranial bleeding and benefits in preventing further thrombotic proliferation need to be assessed.…”

Section: Discussionmentioning

confidence: 99%

Asymmetric Superior Ophthalmic Vein Thrombosis due to Sepsis Induced by a Deep Neck Infection

Kim¹,

Kang²

2015

J Clin Exp Ophthalmol

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Superior ophthalmic vein thrombosis is one of the early signs of cavernous sinus thrombosis. It is characterized by ipsilateral proptosis, ptosis, chemosis, limitations of ocular muscle movement and normal fundus findings. In this article, we present a case of bilateral asymmetric superior ophthalmic vein thrombosis due to sepsis developed from a deep neck infection from a parotid gland abscess.A 49-year-old male patient presented to our emergency department with a history of progressive left neck swelling, ocular pain and conjunctival injection, ptosis, proptosis, and diplopia on his right eye. He had limitations of his extraocular muscle movement in all directions of his right eye, especially abduction and adduction limitations with no midline crossing. It was revealed that the patient was in a septic condition at the emergency department. The findings revealed a diffuse parotid gland abscess and left external carotid vein thrombosis. An incision was performed and drainage was done on next day of the ER visit. His bilateral cavernous sinus yielded a decreased enhancement on the CT scan signifying thrombophlebitis. His right superior ophthalmic vein was filled with a thrombus. The left superior ophthalmic vein was also filled with a thrombus. An orbital MRI also revealed both an ophthalmic vein engorgement due to the thrombus and an enhancement around the extraocular muscle with infiltration. A blood culture test concluded the presence of Staphilococcus auerus, a gram positive microorganism. The patient was maintained on intravenous antibiotics over his admission. After discharge, the proptosis and limited motion of the extraocular muscle dissipated. However, diplopia at the primary position remained.

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Section: Discussionmentioning

confidence: 99%

Asymmetric Superior Ophthalmic Vein Thrombosis due to Sepsis Induced by a Deep Neck Infection

Kim¹,

Kang²

2015

J Clin Exp Ophthalmol

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“…It is a rare complication of facial infection (1,2), paranasal sinusitis (3)(4)(5), otitis media (2) and, less often, pharyngitis (6) and dental infection (3,7). Septic CST is apt to be underdiagnosed as a local eye infection despite the fact that it is potentially lethal with various complications including meningitis (8), subdural abscess (5,9), stroke (9) and pituitary insufficiency (5), because the basic clinical concept of this disorder is not widely recognized among clinicians.…”

Section: Introductionmentioning

confidence: 99%

Septic Cavernous Sinus Thrombosis Complicated by Narrowing of the Internal Carotid Artery, Subarachnoid Abscess and Multiple Pulmonary Septic Emboli

et al. 2007

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A 56-year-old woman was admitted because of a high fever, right ptosis, chemosis, proptosis and ocular muscle palsy. Cranial MRI revealed a cavernous sinus thrombosis and a subarachnoid abscess. Carotid angiogram demonstrated marked stenosis as well as aneurismal formation of the right internal carotid artery at the intracavernous portion. Chest radiograph showed bilateral multiple pulmonary nodules, some of which contained a cavity. Blood culture was positive for Streptococcus constellatus. She was diagnosed with septic cavernous sinus thrombosis complicated by narrowing of the internal carotid artery, subarachnoid abscess and multiple pulmonary septic emboli. She recovered with partial ocular sequelae as a result of seven weeks of intravenous antimicrobial therapy.

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“…The enhanced CT and MRI appearances of STCS demonstrate enlargement of the cavernous sinus and irregular filling defects corresponding to thrombosed compartments. 9 Indirect signs include dilatation of the superior ophthalmic vein with or without associated thrombosis, exophthalmos and increased dural enhancement along the lateral border of the cavernous sinus. 9 Septic thrombosis of the cavernous sinus begins as an infective thrombophlebitis that reaches the cavernous sinus either by direct extension or by venous embolism.…”

mentioning

confidence: 99%

“…9 Indirect signs include dilatation of the superior ophthalmic vein with or without associated thrombosis, exophthalmos and increased dural enhancement along the lateral border of the cavernous sinus. 9 Septic thrombosis of the cavernous sinus begins as an infective thrombophlebitis that reaches the cavernous sinus either by direct extension or by venous embolism. The valveless veins draining to the cavernous sinus predispose the area to the retrograde spread of infection from the face and teeth along the pterygoid plexus and inferior petrosal sinus.…”

mentioning

confidence: 99%

“…3 In such specific cases where the clinical presentation is atypical and unusual, imaging and particularly MRI is of value in detecting and evaluating cavernous sinus abnormalities. 9 MRI is the most sensitive radiological indicator of disease activity. The enhanced CT and MRI appearances of STCS demonstrate enlargement of the cavernous sinus and irregular filling defects corresponding to thrombosed compartments.…”

mentioning

confidence: 99%

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Septic thrombosis of the cavernous sinus secondary to aStreptococcus millerioral infection

Imholz

Becker²,

Lombardi³

et al. 2012

Dentomaxillofacial Radiology

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Septic thrombosis of the cavernous sinus (STCS) is an uncommon and potentially lethal disease. Sphenoid and ethmoid sinusitis followed by facial cutaneous infections represents the most common aetiologies, with Staphylococcus aureus as the main responsible organism followed by the Streptococcus pneumoniae. Although all infectious foci of the head and neck area can potentially spread to the cavernous sinus, STCS from oral infection is an exceptionally rare occurrence. We report the unusual case of a patient who presented with an acute STCS secondary to a generalized Streptococcus milleri periodontitis. This case highlights the importance of systematically performing a detailed examination of the oral cavity in patients presenting with intracranial infections caused by uncommon pathogens such as the Streptococcus milleri group.

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Septic Thrombosis of the Cavernous Sinus: Two Different Mechanisms

Cited by 55 publications

References 12 publications

Asymmetric Superior Ophthalmic Vein Thrombosis due to Sepsis Induced by a Deep Neck Infection

Asymmetric Superior Ophthalmic Vein Thrombosis due to Sepsis Induced by a Deep Neck Infection

Septic Cavernous Sinus Thrombosis Complicated by Narrowing of the Internal Carotid Artery, Subarachnoid Abscess and Multiple Pulmonary Septic Emboli

Septic thrombosis of the cavernous sinus secondary to aStreptococcus millerioral infection

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