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Lu M, Liu S, Peng P, Liu D, Liu Y, Sheng F, Hao F, Zhao X, Han C, He Y, Yuan F, Zhang H, Cai J. The Characteristics of Extracranial Internal Carotid Artery and Their Relationship With Surgical Outcomes in Patients With Moyamoya Disease: A Combined Head-and-Neck Vessel Wall MR Imaging Study. J Magn Reson Imaging 2024; 60:94-102. [PMID: 37823479 DOI: 10.1002/jmri.29047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The features of intracranial arteries in patients with Moyamoya disease (MMD) have been widely investigated. However, the MR characteristics of extracranial internal carotid artery (EICA) and their effect on outcomes of revascularization treatment are not fully understood. PURPOSE To investigate the characteristics of EICA and their relationship with outcomes of revascularization treatment in adult patients with MMD based on higher-resolution MRI (HRMRI). STUDY TYPE Prospective interventional outcomes. SUBJECTS Two hundred eighty-eight consecutive patients with MMD (mean age: 43.7 ± 11.2 years; 140 male). FIELD STRENGTH/SEQUENCE Turbo inversion recovery magnitude T1-weighted imaging and turbo spin echo (TSE) T2-weighted imaging, three-dimensional time-of-flight MR angiography, T2-fluid attenuated inversion recovery, and 3D T1-SPACE vessel wall imaging at 3.0 T. ASSESSMENT The HRMRI characteristics of EICA were determined. The relationship between the characteristics of EICA (proximal stenosis, diffuse wall thickening, carotid plaques, and luminal thrombosis) and stroke outcomes of revascularization treatment in patients with MMD was analyzed. The discriminative ability of EICA characteristics in combination with intracranial carotid artery features (involvement of vessel segments, bilateral involvement, and Suzuki stage) to determine stroke outcomes was compared with that of intracranial artery features alone during a mean 8.0 months follow-up period. STATISTICAL TESTS Cox proportional hazards models and Kaplan-Meier curves to calculate the hazard ratios (HRs) for stroke with 95% confidence intervals (CIs). Area under the receiver operating characteristic curve (AUC) for assessing discriminative performance. A P value <0.05 was considered statistically significant. RESULTS During a mean 8.0 ± 2.2 months follow-up, of the 288 participants, 137 had proximal stenosis (47.6%), 106 had diffuse wall thickening (36.8%), 60 had carotid plaques (20.8%), and 27 had luminal thrombosis (9.4%) of EICA. Of these features, proximal stenosis (HR = 2.86; 95% CI = 1.13-7.29) and diffuse wall thickening (HR = 2.62; 95% CI = 1.16-5.94) of EICA were significantly associated with stroke after surgery, before and after adjusting for confounding factors. In discriminating the stroke outcomes after surgery, combining characteristics of EICA with features of intracranial arteries resulted in a significant incremental improvement (DeLong test, P < 0.05) in the AUC over that obtained with features of intracranial arteries alone (AUC: 0.73 vs. 0.60-0.64). CONCLUSION Proximal stenosis and diffuse wall thickening of EICA were significantly associated with stroke outcomes after surgery in patients with MMD. Our findings suggest that understanding the characteristics of EICA has added value for intracranial vessels in predicting future events after surgery in patients with MMD. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shitong Liu
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Dongqing Liu
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuan Liu
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fugeng Sheng
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangbin Hao
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Cong Han
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yao He
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fei Yuan
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Hongtao Zhang
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianming Cai
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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Pleming W, Barco S, Voci D, Sacco C, Zane F, Granziera S, Corsi G, Konstantinides SV, Kucher N, Pecci A, Valerio L. Cardiac and Cerebral Arterial Complications of Lemierre Syndrome: Results from a Systematic Review and Individual Patient Data Meta-analysis. Hamostaseologie 2022; 42:261-267. [PMID: 35255510 PMCID: PMC9388219 DOI: 10.1055/a-1694-8723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background
Lemierre syndrome is a potentially life-threatening disease, which affects otherwise healthy young adults and adolescents. It is characterized by acute neck vein thrombosis and septic embolism, usually complicating a bacterial infection. Data on the syndrome are sparse, particularly concerning arterial complications.
Methods
We evaluated the frequency and patterns of cerebral arterial and cardiac involvement (“arterial complications”) in an individual patient level cohort of 712 patients, representing all cases described over the past 20 years in the medical literature who fulfilled the criteria: (1) bacterial infection in the neck/head site and (2) objectively confirmed thrombotic complication or septic embolism. The study outcomes were defined as all-cause in-hospital deaths and the occurrence of clinical sequelae at discharge or in the postdischarge period.
Results
A total of 55 (7.7%) patients had an arterial complication. The most frequent arterial complications were carotid involvement (52.7%), stroke (38.2%), and pericardial complications (20%). Patients with an arterial involvement were more likely to be treated with a greater number of antibiotics (23 vs. 10%) and to receive anticoagulation. In addition, patients with arterial complications had a greater risk of all-cause death (
n
= 20/600, 3.3% vs.
n
= 6/52, 12%; odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.5–9.9) and late clinical sequelae (
n
= 49/580, 9.0% vs.
n
= 15/46, 35%; OR: 5.2; 95% CI: 2.65–10.37).
Conclusions
While Lemierre syndrome is known to be primarily characterized by venous thromboembolic events, our results suggest that local or distant arterial complications may occur in approximately one-tenth of patients and may be associated with a greater risk of long-term sequelae and death.
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Affiliation(s)
- William Pleming
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.,Center for Thrombosis and Hemostasis, Mainz University Medical Center, Mainz, Germany
| | - Davide Voci
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Clara Sacco
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federica Zane
- Department of General Medicine, Hospital of Sondrio, Sondrio, Italy
| | - Serena Granziera
- Department of Medicine, Geriatric Unit, Ospedale San Giovanni e Paolo, Venice, Italy
| | - Gabriele Corsi
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola - Malpighi Hospital, Alma Mater University, Bologna, Italy.,IRCCS Azienda Ospedaliero - Universitaria of Bologna, Bologna, Italy
| | | | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Mainz University Medical Center, Mainz, Germany
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3
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Different causes and diverse outcomes of extremely rare septic cavernous sinus thrombosis complicated with internal carotid artery stenosis. Eur J Med Res 2021; 26:120. [PMID: 34615537 PMCID: PMC8493721 DOI: 10.1186/s40001-021-00588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cases of acute sphenoid sinusitis complicated by septic cavernous sinus (CS) thrombosis and internal carotid artery (ICA) stenosis are rarely reported. Different causative pathogens have been reported for this condition. We present two extremely rare and special cases with diverse clinical presentations and outcomes. Case 1 involved a female patient with less extensive sinusitis, but critical ICA occlusion. Case 2 involved a male patient with extensive pansinusitis, meningitis, cerebritis, and vasculitis due to fungal infection, but less stenosis of the ICA lumen. Both patients underwent surgical debridement and received broad-spectrum antibiotics. Additional anti-fungal medication was also administered in Case 2. However, outcomes differed considerably between cases. Discussion Case 1 recovered with minimal neurological deficits and had Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) scores of 5 and 2, respectively; however, the Case 2 had GOS and mRS scores of 3 and 4, respectively. Although rare, septic CS thrombosis with ICA stenosis can lead to unexpected and severe neurological sequelae. Fungal infection can result in catastrophic complications and poorer prognosis. Conclusion In addition to early detection, aggressive surgical debridement and adequate antimicrobial treatment are crucial to satisfactory outcomes in patients with septic CS thrombosis complicated with ICA stenosis.
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Carballo Cuello C, De Jesus O, Labat EJ, Pastrana EA. Lemierre syndrome leading to an ischaemic stroke and malignant cerebral oedema. BMJ Case Rep 2021; 14:14/7/e243690. [PMID: 34253528 DOI: 10.1136/bcr-2021-243690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lemierre syndrome is an often misdiagnosed disease caused by an anaerobic bacterial infection that produces thrombophlebitis of the internal jugular vein and septic metastasis to distal organs, especially the lungs. Carotid stenosis or thrombosis is a rare complication. We present a patient with Lemierre syndrome who developed malignant cerebral oedema secondary to an ischaemic stroke which required a decompressive craniectomy.
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Affiliation(s)
- Cesar Carballo Cuello
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Eduardo J Labat
- Department of Radiological Sciences and Diagnostic Radiology, Neuroradiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Emil A Pastrana
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
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Abstract
Lemierre syndrome is a rare form of septic thrombophlebitis of the head and neck veins, most typically the internal jugular vein, which affects otherwise healthy adolescents and young adults after an oropharyngitis or other local infection and is characterized by multiple septic embolization. Despite treatment, Lemierre syndrome displays a high rate of in-hospital complications that include thrombus progression and new peripheral septic embolization, and it can be fatal or cause disabling sequelae. The mainstay of treatment is antibiotic therapy; anticoagulation is often used, but its role is controversial. Surgical treatment is often necessary in case of peripheral septic lesions. In the absence of prospective studies, what little guidance exists on its management is based on case series or on analogy with similar conditions such as other forms of septic thrombophlebitis or non-septic venous thrombosis. Over the last few years, new observational evidence has improved our knowledge of the clinical epidemiology of this condition and highlighted a number of promising management strategies. We provide an overview of the treatment patterns observed in the contemporary era, summarise the arguments proposed so far against or in favour of alternative treatments as well as possible decision rules on the use of anticoagulation, and outline the priorities of ongoing and future observational and interventional research.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center, University of Mainz, Mainz, Germany -
| | - William Pleming
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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Nygren D, Elf J, Torisson G, Holm K. Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre's Syndrome -A Post Hoc Observational and Population-Based Study of 82 Patients. Open Forum Infect Dis 2020; 8:ofaa585. [PMID: 33447643 PMCID: PMC7793455 DOI: 10.1093/ofid/ofaa585] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Lemierre’s syndrome is typically caused by Fusobacterium necrophorum where an oropharyngeal infection is followed by septic internal jugular vein thrombophlebitis with subsequent septic embolization. Yet, the pathogenesis of septic thrombophlebitis, differences dependent on the presence of jugular vein thrombosis, and the role of anticoagulant therapy are insufficiently understood. Methods Patients with invasive infection with F. necrophorum and Lemierre’s syndrome who had been investigated for jugular vein thrombosis were included from a previous population-based observational study in Sweden. Medical records were reviewed and compared in patients with and without jugular vein thrombosis. Then, patients with jugular vein thrombosis were compared by exposure to therapeutic, prophylactic, or no anticoagulation. Outcomes examined were thrombosis progression, early or late peripheral septic complications, chronic major sequelae, 30-day mortality, and major bleeding. Results Fifty-one of 82 (62%) radiologically investigated patients with Lemierre’s syndrome had jugular vein thrombosis. Patients with jugular vein thrombosis had lower platelet levels (median, 76 vs 112 ×109/L; P = .04) on presentation and more days to defervesence (12 vs 7 days; P = .03) yet similar rates of major sequelae and 30-day mortality. No significant differences in outcomes were seen between patients with jugular vein thrombosis exposed to therapeutic, prophylactic, or no anticoagulation therapy, yet study outcomes were rare. Conclusions Patients with Lemierre’s syndrome with jugular vein thrombosis were more severely affected, yet had similar prognosis. Most patients with jugular vein thrombosis recovered well without therapeutic anticoagulation therapy, though adverse events were similarly rare in anticoagulated patients. The observational design and rarity of study outcomes require cautious interpretation.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Johan Elf
- Center of Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Gustav Torisson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
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Rahimi D, Langkilde AR, Iversen HK, Truelsen TC. Lemierre's syndrome with stroke and stenosis of the internal carotid artery suggesting focal vasculitis. J Neurol Sci 2020; 409:116632. [DOI: 10.1016/j.jns.2019.116632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
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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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9
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Lemierre's Syndrome Associated Mycotic Aneurysm of the External Carotid Artery with Primary Internal Carotid Artery Occlusion in a Previously Healthy 18-Year-Old Female. Ann Vasc Surg 2016; 36:291.e11-291.e14. [PMID: 27421193 DOI: 10.1016/j.avsg.2016.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/21/2022]
Abstract
Lemierre's syndrome is a rare life-threatening condition characterized by internal jugular vein thrombosis and is typically associated with a gram-negative infection with septic metastasis secondary to a retropharyngeal abscess that involves the vasculature of the head and neck. We report a case of Lemierre's syndrome in an 18-year-old female adolescent who developed an internal carotid artery occlusion and ipsilateral external carotid artery (ECA) mycotic aneurysm complicated by fulminant pseudomonal sepsis. The patient was managed with open ligation of the ECA with essentially complete recovery.
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10
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Bird NTE, Cocker D, Cullis P, Schofield R, Challoner B, Hayes A, Brett M. Lemierre's disease: a case with bilateral iliopsoas abscesses and a literature review. World J Emerg Surg 2014; 9:38. [PMID: 24904685 PMCID: PMC4046005 DOI: 10.1186/1749-7922-9-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/17/2014] [Indexed: 12/05/2022] Open
Abstract
Lemierre's disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701-3, 1936. Clin Microbiol Rev 20(4):622-59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The case report describes an unusual case of Lemierre's disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess. To our knowledge, this is the first reported case of Lemierre's disease in the context of bilateral psoas abscesses, and highlights the ambiguity surrounding the definition of Lemierre's disease. The clinical literature review highlights the difficulty in definitively diagnosing the condition and offers some suggestions for recognising and refining the diagnostic criterion of Lemierre's.
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Affiliation(s)
- Nicholas TE Bird
- General Surgery, University Hospital Aintree, Lower Lane, Liverpool L97AL, UK
| | - Derek Cocker
- Infectious Diseases, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Paul Cullis
- General Surgery, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Richard Schofield
- General Surgery, Warrington Hospital, Lovely Lane, Warrington WA5 1QG, UK
| | - Ben Challoner
- General Surgery, University Hospital Aintree, Lower Lane, Liverpool L97AL, UK
| | - Alastair Hayes
- General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - Martin Brett
- General Surgery, Warrington Hospital, Lovely Lane, Warrington WA5 1QG, UK
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Síndrome de Lemierre asociado a trombosis de vena yugular externa derecha. Med Intensiva 2013; 37:120-1. [DOI: 10.1016/j.medin.2012.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 05/04/2012] [Accepted: 05/08/2012] [Indexed: 11/22/2022]
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Katayama W, Fujita K, Onuma K, Kamezaki T, Sakashita S, Sugita S. Cerebral venous thrombosis associated with micro-abscesses: case report. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 118:321-324. [PMID: 23564158 DOI: 10.1007/978-3-7091-1434-6_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a case that is most likely Lemierre's syndrome. A 19-year-old man presented to us with -common-cold-like symptoms, which he had had for 2 days, such as slight fever, general malaise, anorexia, sore throat, and headache. Eight days after the onset of these symptoms, he died of brain herniation due to cerebral venous thrombosis associated with micro-abscesses detected in pathological examination.
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Affiliation(s)
- Wataru Katayama
- Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan.
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Rudski Ricondo L, Ramos Gómez MJ, Aguilar Cantador J, Bravo-Rodríguez FA. Lemierre Syndrome: Thrombosis of the Cavernous Sinus and Internal Carotid Artery Occlusion Secondary to Acute Sphenoid Sinusitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kuppalli K, Livorsi D, Talati NJ, Osborn M. Lemierre's syndrome due to Fusobacterium necrophorum. THE LANCET. INFECTIOUS DISEASES 2012; 12:808-15. [PMID: 22633566 DOI: 10.1016/s1473-3099(12)70089-0] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We present a case of a patient with Lemierre's syndrome caused by Fusobacterium necrophorum who developed a right frontal lobe brain abscess. We summarise the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, complications, therapy, and outcomes of Lemierre's syndrome. F necrophorum is most commonly associated with Lemierre's syndrome: a septic thrombophlebitis of the internal jugular vein. Patients usually present with an exudative tonsillitis, sore throat, dysphagia, and unilateral neck pain. Diagnosis of septic thrombophlebitis is best confirmed by obtaining a CT scan of the neck with contrast. Complications of the disease include bacteraemia with septic abscesses to the lungs, joints, liver, peritoneum, kidneys, and brain. Treatment should include a prolonged course of intravenous beta-lactam antibiotic plus metronidazole.
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Affiliation(s)
- Krutika Kuppalli
- Department of Medicine, Division of Infectious Diseases, Division of Global Public Health, University of California, San Diego, San Diego, CA 92103-8208, USA.
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Rudski Ricondo L, Ramos Gómez MJ, Aguilar Cantador J, Bravo-Rodríguez FA. [Lemierre syndrome: thrombosis of the cavernous sinus and internal carotid artery occlusion secondary to acute sphenoid sinusitis]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:75-7. [PMID: 22424548 DOI: 10.1016/j.otorri.2011.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 08/11/2011] [Accepted: 08/29/2011] [Indexed: 10/28/2022]
Abstract
Lemierre syndrome (LS) typically consists of a septic thrombophlebitis of the internal jugular vein caused by Fusobacterium necrophorum. We present an unusual variant of LS with cavernous sinus thrombosis and occlusion of the ipsilateral internal carotid artery secondary to sphenoid sinusitis caused by Streptococcus viridans.
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Affiliation(s)
- Luciana Rudski Ricondo
- Sección de Neurorradiología Diagnóstica y Terapéutica, Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, España.
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