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Radiographic and Clinical Analysis of Cranio-Maxillofacial Complications of Cavernous Sinus Thrombosis Among 256 COVID-19 Patients. J Craniofac Surg 2022; 33:1549-1553. [PMID: 35758470 PMCID: PMC9275805 DOI: 10.1097/scs.0000000000008680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
A heavy burden of cranio-maxillofacial complications may be encountered in corona virus disease-2019 patients due to the associated coagulopathy and inflammatory consequences of the disease. This study aims to describe clinical and radiographic features of these complications in 256 patients who developed 1 or more of the following complications: cavernous sinus thrombosis, osteomyelitis or necrosis of the jaws.
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2
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Aljanabi KSK, Almaqbali T, Alkilidar AAH. A covid-19 Patient with Cavernous Sinus Thrombosis Post Dental Extraction a Diagnostic Dilemma. Indian J Otolaryngol Head Neck Surg 2021; 74:2887-2890. [PMID: 33654682 PMCID: PMC7908007 DOI: 10.1007/s12070-021-02460-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Prior to the antibiotics era, the mortality rate from cavernous sinus thrombosis (CST) was very high reaching 100%. There have been very few reports of CST associated with tooth extraction on the same time Coronavirus disease of 2019 (COVID-19) is known to increase the risk of developing venous thromboembolism; therefore, patients with COVID-19 may present with cerebral venous sinus thrombosis. We present a case with diagnostic dilemma and first to be reported in the literature.
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3
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Dan TF, Jianu SN, Iacob N, Motoc AGM, Munteanu G, Băloi A, Albulescu N, Jianu DC. Management of an old woman with cavernous sinus thrombosis with two different mechanisms: case report and review of the literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:1329-1334. [PMID: 34171082 PMCID: PMC8343534 DOI: 10.47162/rjme.61.4.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022]
Abstract
Cavernous sinus thrombosis (CST) usually produces a characteristic clinical syndrome. Septic CST represents a sporadic, but severe complication of infection of the cavernous sinuses, which can bring high mortality and morbidity rates if not treated right away. Case presentation: The current research is a case report of a 64-year-old woman with inherited thrombophilia who developed an acute mastoid infection that resulted in septic right CST. The clinical diagnosis was verified by laboratory studies and evidence from high-resolution computed tomography (HRCT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Clinical medical care resulted in the patient being successfully treated with low-molecular-weight heparin and broad-spectrum intravenous antibiotics, which avoided severe complications.
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Affiliation(s)
- Traian Flavius Dan
- Department of Neurology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Silviana Nina Jianu
- Department of Ophthalmology, Dr. Victor Popescu Military Emergency Hospital, Timişoara, Romania
| | - Nicoleta Iacob
- Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Neuromed Diagnostic Imaging Centre, Timişoara, Romania
| | - Andrei Gheorghe Marius Motoc
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- Department of Anatomy and Embryology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Georgiana Munteanu
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Adelina Băloi
- Department of Anesthesia and Intensive Care, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Nicolae Albulescu
- Department of Cardiology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
| | - Dragoş Cătălin Jianu
- Department of Neurology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
- First Department of Neurology, Pius Brânzeu Emergency County Hospital, Timişoara, Romania
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4
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Spaziante M, Giuliano S, Ceccarelli G, Alessandri F, Borrazzo C, Russo A, Venditti M. Gram-negative septic thrombosis in critically ill patients: A retrospective case-control study. Int J Infect Dis 2020; 94:110-115. [PMID: 32126323 DOI: 10.1016/j.ijid.2020.02.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Data on septic thrombosis caused by Gram-negative bacilli (GN-ST) in intensive care unit (ICU) patients are currently limited. METHODS The aim of this retrospective case-control study (matched 1:3) performed over a 15-month period on ICU patients with bacteraemia, associated (cases) or not (controls) with GN-ST, was to assess 30-day mortality and clinical/microbiological features of GN-ST. RESULTS During the study period, 16 patients with GN-ST and 48 controls were analyzed. Polytrauma was the cause of ICU admission in 12 (75%) cases and 22 (46%) controls (p = 0.019). In no case of septic thrombosis was surgical debridement performed. The site of venous thrombosis was more frequently in the lower limbs, associated with bone fracture in nine out of 12 (75%) cases. The median duration of bacteraemia (22 days vs 1 day; p < 0.001) and time to clinical improvement (15 days vs 4 days; p < 0.001) were significantly longer in cases than in controls. On analysis of the receiver operating characteristics (ROC) curve, bacteraemia >72 h was significantly associated with GN-ST (area under the curve (AUC) 0.95, sensitivity 0.996 and specificity 0.810; p < 0.001). Finally, 30-day mortality was 20% in cases and 67% in controls (p < 0.001). CONCLUSIONS Critically ill patients with GN-ST showed specific clinical features. Despite delayed bacteraemia clearance, targeted antibiotic therapy plus anticoagulation usually provided clinical improvement and a low 30-day mortality rate.
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Affiliation(s)
- Martina Spaziante
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | | | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Alessandri
- Department of Anaesthesia and Intensive Care Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
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5
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Denny KJ, Kumar A, Timsit JF, Laupland KB. Extra-cardiac endovascular infections in the critically ill. Intensive Care Med 2019; 46:173-181. [PMID: 31745594 DOI: 10.1007/s00134-019-05855-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023]
Abstract
Vascular infections are associated with high complication rates and mortality. While there is an extensive body of literature surrounding cardiac infections including endocarditis, this is less so the case for other endovascular infections. The objective of this narrative review is to summarize the epidemiology, clinical features, and selected management of severe vascular infections exclusive of those involving the heart. Endovascular infections may involve either the arterial or venous vasculature and may arise in native vessels or secondary to implanted devices. Management is complex and requires multi-disciplinary involvement from the outset. Infective arteritis or device-related arterial infection involves removal of the infected tissue or device. In cases where complete excision is not possible, prolonged courses of antimicrobials are required. Serious infections associated with the venous system include septic thrombophlebitis of the internal jugular and other deep veins, and intracranial/venous sinuses. Source control is of paramount importance in these cases with adjunctive antimicrobial therapy. The role of anticoagulation is controversial although recommended in the absence of contraindications. An improved understanding of the management of these infections, and thus improved patient outcomes, requires multi-center, international collaboration.
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Affiliation(s)
- Kerina J Denny
- Department of Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia.,Burns, Trauma and Critical Care Research Centre, University of Queensland, Herston, QLD, Australia
| | - Anand Kumar
- Sections of Critical Care Medicine and Infectious Diseases, Health Sciences Centre, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jean-Francois Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia.
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Maharaj S, Ahmed S, Pillay P. Deep Neck Space Infections: A Case Series and Review of the Literature. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619871274. [PMID: 31496858 PMCID: PMC6716171 DOI: 10.1177/1179550619871274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022]
Abstract
Deep neck spaces are regions of loose connective tissue filling areas between the
3 layers of deep cervical fascia, namely, superficial, middle, and deep layers.
The superficial layer is the investing layer, The pretracheal layer is the
intermediate layer and the prevertebral layer is the deepest layer. Deep neck
space infection (DNI) is defined as an infection in the potential spaces and
actual fascial planes of the neck. Once the natural resistance of fascial planes
is overcome, spread of infection occurs along communicating fascial boundaries.
More recent trends include the increasing prevalence of resistant bacterial
strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative
increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are
purely aerobic and 25% with isolated anaerobes. The epidemiology of DNIs needs
to be monitored for changing trends and the impact of underlying host immunity
and developing microbial multidrug resistance is established. Surveillance at
laboratory level should include mandatory susceptibility testing of all empiric
antibiotics against microbes commonly identified in adult DNI microscopy,
culture, and sensitivity (MC&S) specimens. The role of susceptibility
testing of microbes not commonly identified in adult DNI MC&S specimens
needs further review, on a clinical case-by-case basis.
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Affiliation(s)
- Shivesh Maharaj
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Sumaya Ahmed
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Preba Pillay
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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7
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Coburn JA, Golden E, Brucker J, Kennedy TA. Nontraumatic Vascular Emergencies of the Neck. Semin Ultrasound CT MR 2019; 40:157-171. [PMID: 31030739 DOI: 10.1053/j.sult.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nontraumatic vascular emergencies of the head and neck are uncommon, but can occur in patients with central venous catheters, head and neck infections, and in patients with head and neck cancer. Recognizing the imaging findings of vascular complications in these patient populations is critically important to ensure expeditious treatment to avoid significant morbidity and mortality.
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Affiliation(s)
- John A Coburn
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edwarda Golden
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin Brucker
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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8
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Aggarwal K, Rastogi S, Joshi A, Kumar A, Chaurasia A, Prakash R. Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity. J Korean Assoc Oral Maxillofac Surg 2017; 43:351-355. [PMID: 29142871 PMCID: PMC5685866 DOI: 10.5125/jkaoms.2017.43.5.351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/17/2017] [Accepted: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.
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Affiliation(s)
- Karun Aggarwal
- Department of Oral and Maxillofacial Surgery, Jodhpur Dental College and Hospital, Jodhpur, India
| | - Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Center (KDCRC), Moradabad, India
| | - Atul Joshi
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, India
| | - Ashish Kumar
- Department of Public Health Dentistry, BJS Dental College and Research Center, Ludhiana, India
| | - Archana Chaurasia
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, India
| | - Rajat Prakash
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, India
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9
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Nagarakanti S, Bishburg E, Brown M. Cavernous Sinus Thrombosis due to Streptococcus mitis and Staphylococcus lugdunensis. J Clin Diagn Res 2016; 10:OD13-OD14. [PMID: 27790500 DOI: 10.7860/jcdr/2016/21521.8545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/07/2016] [Indexed: 12/25/2022]
Abstract
Cavernous Sinus Thrombosis (CST) is a rare, life-threatening condition that may result from the direct spread of infection from the nose, ears, teeth or sinuses. It is most commonly caused by Staphylococcus aureus and Streptococcus sp. We present a case of CST caused by Strepotococcus mitis and Staphylococcus lugdunensis. Early surgical intervention with aggressive medical management is needed as the syndrome carries a high mortality. To our knowledge this is the first case of CST associated with these two organisms.
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Affiliation(s)
- Sandhya Nagarakanti
- Clinical Assistant Professor, Newark Beth Israel Medical Center , Newark, New Jersey, USA
| | - Eliahu Bishburg
- Clinical Associate Professor, Newark Beth Israel Medical Center , Newark, New Jersey, USA
| | - Melinda Brown
- Attending Physician and Clinical Researcher, St. Michael Medical Center , Newark, New Jersey, USA
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10
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Cramer JD, Purkey MR, Smith SS, Schroeder JW. The impact of delayed surgical drainage of deep neck abscesses in adult and pediatric populations. Laryngoscope 2016; 126:1753-60. [DOI: 10.1002/lary.25835] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/05/2015] [Accepted: 11/27/2015] [Indexed: 11/08/2022]
Affiliation(s)
- John D. Cramer
- Department of Otolaryngology-Head and Neck Surgery; Chicago Illinois U.S.A
| | - Matthew R. Purkey
- Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery; Chicago Illinois U.S.A
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
| | - James W. Schroeder
- Department of Otolaryngology-Head and Neck Surgery; Chicago Illinois U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Ann and Robert H. Lurie Children's Hospital; Chicago Illinois U.S.A
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11
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Maroldi R, Farina D, Ravanelli M, Lombardi D, Nicolai P. Emergency imaging assessment of deep neck space infections. Semin Ultrasound CT MR 2013; 33:432-42. [PMID: 22964409 DOI: 10.1053/j.sult.2012.06.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Deep neck space infection may lead to severe and potentially life-threatening complications, such as airway obstruction, mediastinitis, septic embolization, dural sinus thrombosis, and intracranial abscess. The clinical presentation is widely variable, and often early symptoms do not reflect the disease severity. The complication risk depends on the extent and anatomical site: diseases that transgress fascial boundaries and spread along vertically oriented spaces (parapharyngeal, retropharyngeal, and paravertebral space) have a higher risk of complications and require a more aggressive treatment compared with those confined within a nonvertically oriented space (peritonsillar, sublingual, submandibular, parotid, and masticator space). Imaging has 5 crucial roles: (1) confirm the suspected clinical diagnosis, (2) define the precise extent of the disease, (3) identify complications, (4) distinguish between drainable abscesses and cellulitis, and (5) monitor deep neck space infection progression. Ultrasonography is the gold standard to differentiate abscesses from cellulitis, for the diagnosis of lymphadenitis. and to identify internal jugular thrombophlebitis in the infrahyoid neck. However, field-of-view limitation and poor anatomical information confine the use of ultrasonography to the evaluation of superficial lesions and to image-guided aspiration or drainage. Computed tomography (CT) combines fast image acquisition and precise anatomical information without field-of-view limitations. For these reasons, it is the most reliable technique for the evaluation of deep and multicompartment lesions and for the identification of mediastinal and intracranial complications. Contrast agent administration enhances the capability to differentiate fluid collections from cellulitis and allows the detection of vascular complications. Magnetic resonance imaging is more time-consuming than CT, limiting its use to selected indications. It is the technique of choice for assessing the epidural space involvement in pre- and paravertebral space infections and complements CT in the evaluation of the infections reaching the skull base.
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Affiliation(s)
- Roberto Maroldi
- Department of Radiology, University of Brescia, Brescia, Italy.
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12
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Abstract
Glycemic control is an important aspect of patient care in the surgical Infections of the nervous system are among the most difficult infections in terms of the morbidity and mortality posed to patients, and thereby require urgent and accurate diagnosis. Although viral meningitides are more common, it is the bacterial meningitides that have the potential to cause a rapidly deteriorating condition that the physician should be familiar with. Viral encephalitis frequently accompanies viral meningitis, and can produce focal neurologic findings and cognitive difficulties that can mimic other neurologic disorders. Brain abscesses also have the potential to mimic and present like other neurologic disorders, and cause more focal deficits. Finally, other infectious diseases of the central nervous system, such as prion disease and cavernous sinus thrombosis, are explored in this review.
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Affiliation(s)
- Vevek Parikh
- University of California, San Francisco, CA, USA
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13
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Pitsiou G, Kachrimanidou M, Papa A, Kioumis I, Paspala A, Boutou A, Vlachou S, Tsorlini E, Argyropoulou-Pataka P. Lemierre's syndrome presenting to the ED: rapidly fatal sepsis caused by methicillin-susceptible Staphylococcus aureus Staphylococcus protein A type t044. Am J Emerg Med 2012; 31:268.e5-7. [PMID: 22795989 DOI: 10.1016/j.ajem.2012.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022] Open
Abstract
We describe the case of a fatal septic illness in a previously healthy young man caused by community-acquired methicillin-susceptible Staphylococcus aureus of Staphylococcus protein A (spa) type t044. The patient developed a devastating Lemierre-like syndrome with extensive thrombosis of inferior vena cava and iliac veins with multiple metastatic septic emboli of the lungs. He presented to the emergency department with rapidly progressing sepsis followed by multiple organ dysfunction syndrome. Recognition of such virulent community-acquired strains is of great importance because they could prove to be emerging pathogens for life-threatening diseases.
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Affiliation(s)
- Georgia Pitsiou
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G.H. G. Papanikolaou, Exohi, Thessaloniki, 57010, Greece.
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14
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Abstract
Infectious and inflammatory processes of the intracranial compartment often result in acute clinical presentations. The possible causes are legion. Clues to the diagnosis involve clinical presentation, laboratory analysis, and neuroimaging. This article reviews some of the salient factors in understanding intracranial infection/ inflammation, including pathophysiology and neuroimaging protocols/findings, and provides some examples and a few "pearls and pitfalls."
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