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Gietzelt C, Wiedemann J, Lappas A, Koch K, Fricke J, Neugebauer A, Nähle CP, Hedergott A. [Thrombosis of the superior ophthalmic vein-A case series and review of the literature]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02106-5. [PMID: 39266751 DOI: 10.1007/s00347-024-02106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/18/2024] [Accepted: 08/05/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Thrombosis of the superior ophthalmic vein (SOV) is rare. It can present with heterogeneous symptoms and requires a careful diagnostic work-up. METHODS This article reports on a case series of three female patients with thrombosis of the SOV and performed an extensive review of the existing literature in PubMed. RESULTS All three patients showed different leading symptoms but all had a triad of restricted eye motility, exophthalmos and a difference in intraocular pressure with the higher pressure on the side of the protruded eyeball. The pathophysiological background differed in all cases: in the two first cases a pre-existing anticoagulation treatment had been paused shortly before the event. Cofactors were an intraorbital venous outflow obstruction due to an unclear mass in the orbital apex in one case and hypercoagulability due to a malignant disease in the other case. In the third case, there was a cavernous sinus fistula. CONCLUSION The diagnosis should be considered not only in patients with dilated vessels of the anterior segment but also in unclear cases of exophthalmos or unilateral elevated intraocular pressure (IOP).
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Affiliation(s)
- Caroline Gietzelt
- Zentrum für Augenheilkunde, Universität zu Köln, 50924, Köln, Deutschland.
| | - Johanna Wiedemann
- Zentrum für Augenheilkunde, Universität zu Köln, 50924, Köln, Deutschland
| | - Alexandra Lappas
- Zentrum für Augenheilkunde, Universität zu Köln, 50924, Köln, Deutschland
| | - Konrad Koch
- Zentrum für Augenheilkunde, Universität zu Köln, 50924, Köln, Deutschland
- MVZ Augenärztliches Diagnostik- und Therapiecentrum (ADTC) Mönchengladbach/Erkelenz GmbH, Erkelenz, Deutschland
| | - Julia Fricke
- Zentrum für Augenheilkunde, Universität zu Köln, 50924, Köln, Deutschland
| | - Antje Neugebauer
- Zentrum für Augenheilkunde, Universität zu Köln, 50924, Köln, Deutschland
| | - Claas Philip Nähle
- Institut für Diagnostische und Interventionelle Radiologie, Universität zu Köln, Köln, Deutschland
- Radiologische Allianz, Hamburg, Deutschland
| | - Andrea Hedergott
- Zentrum für Augenheilkunde, Universität zu Köln, 50924, Köln, Deutschland
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2
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Das N, Gonnah R, Espinoza GM. Sepsis-Induced Cavernous Sinus Thrombosis and Superior Orbital Vein Thrombosis. J Neuroophthalmol 2024; 44:e429-e430. [PMID: 37184965 DOI: 10.1097/wno.0000000000001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Nikhil Das
- School of Medicine (ND), Saint Louis University, St. Louis, Missouri; Department of Ophthalmology and Visual Science (RG), University of Chicago, Chicago, Illinois; and Department of Ophthalmology (GME), School of Medicine, Saint Louis University, Saint Louis University Eye Institute, St. Louis, Missouri
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3
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Yi R, Gabbard R, Pratt J, Chang K, Patel RM, Robinson M. Isolated Superior Ophthalmic Vein Thrombosis. Ophthalmic Plast Reconstr Surg 2024; 40:e166-e168. [PMID: 38771897 DOI: 10.1097/iop.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
The purpose of this article is to report a rare case of isolated superior ophthalmic vein thrombosis. A 74-year-old female presented to the emergency department with a sudden onset of eye pain and bulging. Ophthalmological examination was remarkable for proptosis and ptosis with chemosis of the OS. Neuroimaging demonstrated an isolated superior ophthalmic vein thrombosis secondary to presumed thrombosis of the superior vein varix. Hypercoagulable, infectious, and autoimmune lab workups were unremarkable. The patient was initiated on anticoagulation with the eventual resolution of her symptoms. Isolated superior ophthalmic vein thrombosis is an uncommon diagnosis that requires urgent evaluation to prevent vision loss. Risk factors are multifactorial with infectious being the most common etiology. Our case is unique in that there was no identifiable risk factor.
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Affiliation(s)
- Richard Yi
- Department of Ophthalmology, University of South Carolina/Prisma Health
| | - Ryan Gabbard
- Department of Ophthalmology, University of South Carolina/Prisma Health
| | - James Pratt
- Department of Ophthalmology, University of South Carolina School of Medicine, Columbia, South Carolina, U.S.A
| | - Kenneth Chang
- Department of Ophthalmology, University of South Carolina/Prisma Health
| | - Rakesh M Patel
- Department of Ophthalmology, University of South Carolina/Prisma Health
| | - Mark Robinson
- Department of Ophthalmology, University of South Carolina/Prisma Health
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4
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Cape HT, Gupta L, Blanchard CC, Raslau FD, Timoney PJ. Tumor versus bland thrombus: diffuse large B-cell lymphoma presenting as cavernous sinus and left superior ophthalmic vein thrombosis. Orbit 2024:1-5. [PMID: 39192768 DOI: 10.1080/01676830.2024.2393416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/11/2024] [Indexed: 08/29/2024]
Abstract
A 66-year-old female with a history of sinusitis presented with persistent diplopia and worsening eyelid swelling. Examination revealed bilateral vision loss, cranial nerve palsies, left-sided chemosis, proptosis, and edema. Initial imaging showed sphenoid sinus opacification, bilateral ethmoid disease, lack of filling of bilateral cavernous sinuses, and partial thrombosis of the left superior ophthalmic vein. The sinus findings were evaluated with endoscopic sinus surgery, which was unremarkable. Subsequent orbital imaging suggested the lesions were in keeping with tumor thrombus as opposed to bland thrombus. CT scans revealed a large mass in the right axilla, which was biopsied and confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was treated with anticoagulation, steroids, and chemotherapy resulting in marked improvement. Our report highlights a rare case of tumor thrombus from DLBCL causing bilateral cavernous sinus thrombosis and, to the best of our knowledge, the first documented case of superior ophthalmic vein thrombosis from tumor thrombus.
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Affiliation(s)
- Hays T Cape
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Lalita Gupta
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Cody C Blanchard
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Flavius D Raslau
- Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peter J Timoney
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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5
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Sigurdsson S, Bohman E, Träisk F, Arnljots U. Glucocorticoids in the treatment of non-infectious superior ophthalmic vein thrombosis - Three cases and a review of the literature. Am J Ophthalmol Case Rep 2024; 34:102027. [PMID: 38516054 PMCID: PMC10955203 DOI: 10.1016/j.ajoc.2024.102027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 11/30/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose Superior ophthalmic vein thrombosis (SOVT) is a rare clinical entity, which can have a septic and an aseptic cause. Aseptic SOVT is typically treated with anticoagulation. Glucocorticoids are reserved for cases with concurrent orbital inflammation.We present three cases of SOVT due to carotid cavernous fistula not responding to standard treatment, subsequently successfully treated with glucocorticoids. Observations Three patients with various degrees of proptosis, ophthalmoplegia, orbital stasis and reduced vision are presented. One patient was confirmed to have isolated SOVT, while the other two had associated cavernous sinus thrombosis. All patients had underlying carotid-cavernous fistula without signs of infection. All patients were initially treated with parenteral anticoagulation. Two patients were treated with intraocular pressure-reducing medication. One of whom underwent canthotomy-cantholysis. Two patients experienced a gradual worsening of symptoms during treatment with anticoagulation, while one patient improved before deteriorating. All patients received additional treatment with glucocorticoids consisting of a three-day treatment with intravenous methylprednisolone 500 mg, followed by oral glucocorticoids resulting in total regression of symptoms. Two patients regained 20/20 vision, with some vision field defects, while the third patient regained 20/25 vision. Conclusion and importance The addition of glucocorticoids in the treatment of aseptic SOVT can lead to improvement of symptoms and a potentially better prognosis. However, the risk of complications of glucocorticoid treatment must be carefully considered on a case-by-case basis.
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Affiliation(s)
| | - Elin Bohman
- St. Erik Eye Hospital, Stockholm, Sweden
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frank Träisk
- St. Erik Eye Hospital, Stockholm, Sweden
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Urszula Arnljots
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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6
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Boutaj T, Lazaar H, Benkirane R, Sbai L, Tabchi M, Hilali Z, El Hachimi R, Tachfouti S, Amazouzi A, Cherkaoui O. Superior ophthalmic vein thrombosis in unique double origin: a case report. Pan Afr Med J 2024; 47:119. [PMID: 38828422 PMCID: PMC11143067 DOI: 10.11604/pamj.2024.47.119.42983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 06/05/2024] Open
Abstract
Superior ophthalmic vein thrombosis (SOVT) is a rare orbital pathology. It can cause serious complications if it isn´t diagnosed appropriately. It can be secondary to many etiologies, septic or aseptic ones. Diabetic ketoacidosis (DKA) may disturb the vascular endothelium and promote a prothrombotic state. The presence of which is related to a significantly increased risk of morbidity and mortality. We report the case of a 45-year-old woman who presented a SOVT revealing DKA. Orbit magnetic resonance imaging (MRI) showed thrombosis of the right superior ophthalmic vein. A treatment based on thrombolytic treatment, associated with antibiotic coverage and a glycemic balance was initiated. This case highlights the importance of considering both infection and diabetes as an important part of the diagnosis and management of SOVT.
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Affiliation(s)
- Taha Boutaj
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Hamza Lazaar
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Romaissae Benkirane
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Latifa Sbai
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Manal Tabchi
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Zineb Hilali
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Rim El Hachimi
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Samira Tachfouti
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Abdellah Amazouzi
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
| | - Ouafa Cherkaoui
- Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco
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7
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Menke BA, Ryu C, Chundury RV. Superior Ophthalmic Vein Thrombosis Associated With Asymptomatic COVID-19 Infection. Ophthalmic Plast Reconstr Surg 2024; 40:e41-e42. [PMID: 38427840 DOI: 10.1097/iop.0000000000002540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Superior ophthalmic vein thrombosis is a rare condition scarcely described in clinical literature with potentially severe consequences including permanent vision loss. This report details the case of a 70-year-old woman who presented with acute binocular horizontal diplopia, relative proptosis of the OD by 4 mm, and pain OD. On exam, visual acuity was 20/20 OD and 20/30 OS with full extraocular movements. CT revealed proptosis OD with a thrombosed superior ophthalmic varix. Evaluation for etiology of hypercoagulability was unremarkable, although the patient did have an asymptomatic COVID-19 infection 1 month prior. To the authors' knowledge, this is the first reported case of superior ophthalmic vein thrombosis secondary to an asymptomatic COVID-19 infection.
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Affiliation(s)
- Bryant A Menke
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, U.S.A
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8
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Yoon HJ, Lee JH, Lee SU, Kim JS. Bilateral Superior Ophthalmic Vein Thrombosis as the Sole Manifestation of Protein S Deficiency. J Neuroophthalmol 2023:00041327-990000000-00536. [PMID: 38117562 DOI: 10.1097/wno.0000000000002060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Ho-Jin Yoon
- Department of Neurology (H-JY, J-HL, S-UL), Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-Ophthalmology Laboratory (S-UL), Korea University Anam Hospital, Seoul, South Korea; Department of Neurology (J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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9
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Benish M, Shrot S, Barg A, Kventsel I, Elhasid R, Kenet G, Levy-Mendelovich S. Ocular venous occlusion in pediatrics: Should thrombophilia investigation and anticoagulant treatment be initiated? Pediatr Blood Cancer 2023; 70:e30689. [PMID: 37740614 DOI: 10.1002/pbc.30689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
Retinal vein occlusion (RVO) and superior ophthalmic vein thrombosis (SOVT) are rare diseases in the pediatric population; however, the ophthalmic and neurologic morbidity are significant. As published data are scarce for these conditions, we present our experience with pediatric ocular venous thrombosis in four patients, and discuss recommended management for evaluation and treatment. We suggest performing thrombophilia workup for all pediatric patients with RVO or SOVT. In patients with thrombophilia risk factors or patients with additional thrombi, we highly recommend initiating anticoagulation therapy. There is a need for more research in order to determine the optimal management strategy.
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Affiliation(s)
- Marganit Benish
- Department of Pediatric Hematology and Oncology, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shrot
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Assaf Barg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia and thrombosis Center, Amalia Biron thrombosis Research Institue, Sheba Medical Center, Ramat Gan, Israel
- Department of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Iris Kventsel
- Department of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ronit Elhasid
- Department of Pediatric Hematology and Oncology, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kenet
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia and thrombosis Center, Amalia Biron thrombosis Research Institue, Sheba Medical Center, Ramat Gan, Israel
| | - Sarina Levy-Mendelovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia and thrombosis Center, Amalia Biron thrombosis Research Institue, Sheba Medical Center, Ramat Gan, Israel
- Talpiot sheba leadership program, Sheba medical center, Ramat Gan, Israel
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10
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Tbini M, Ben Ayed M, Boumediene M, Jrad M, Ben Salah M. A superior ophthalmic vein thrombosis following an acute pansinusitis: A case report. Int J Surg Case Rep 2023; 106:108173. [PMID: 37060761 PMCID: PMC10139902 DOI: 10.1016/j.ijscr.2023.108173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 04/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Superior ophthalmic vein thrombosis (SOVT) is a very rare condition that can occur following either septic or aspetic causes. Early recognition and management is important in order to avoid vision-threatening and fatal complications. CASE PRESENTATION A 28-year-old man presented with orbital cellulitis complicating acute pansinusitis. CT scan revealed ipsilateral SOVT. The patient received intravenous antibiotics and anticoagulation with strict ophthalmic monitoring. No orbital complications were recorded during the course of treatment. CLINICAL DISCUSSION SOVT is caused either by septic or aseptic causes. Treatment depends on the etiology. Corticosteroids and anticoagulants are controversial. CONCLUSION Early diagnosis is key to successful management of SOVT.
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Affiliation(s)
- Makram Tbini
- ENT Department, Charles Nicolle Hospital, Boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia.
| | - Mariam Ben Ayed
- ENT Department, Charles Nicolle Hospital, Boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
| | - Miriam Boumediene
- Radiology Department, Charles Nicolle Hospital, Boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
| | - Myriam Jrad
- Radiology Department, Charles Nicolle Hospital, Boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
| | - Mamia Ben Salah
- ENT Department, Charles Nicolle Hospital, Boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
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Teodoru CA, Munteanu M, Mercea N, Moatar A, Stanca H, Popescu FG, Dura H, Hașegan A, Giurgiu DI, Cerghedean-Florea ME. Ophthalmic Vein Thrombosis Associated with Factor V Leiden and MTHFR Mutations. Diagnostics (Basel) 2023; 13:diagnostics13061052. [PMID: 36980359 PMCID: PMC10047011 DOI: 10.3390/diagnostics13061052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Superior ophthalmic vein thrombosis (SOVT) is a rare clinical entity that may be associated with hypercoagulability status. We present a case of a 77-year-old woman who presented to the emergency department complaining of eye ptosis, chemosis and conjunctival congestion in the right eye (RE). The ophthalmological examination revealed best-corrected visual acuity (BCVA) was 0.5 for the right eye (RE) 0.5 and 0.06 for the left eye (LE). Intraocular pressure (IOP) was 25 mmHg in RE and 14 mmHg in LE. Non-contrast computed tomography (CT) of the brain and orbits revealed a hyperreflectivity at the level of the right ophthalmic vein and inferior rectus muscle hypertrophy. An extensive hypercoagulable panel was completed and we found a positive result for Factor V Leiden (heterozygous mutation) and methyl-enetetrahydrofolate reductase (MTHFR-C677T homozygous mutations). Systemic steroidal anti-inflammatory and anticoagulant treatments were started immediately. Gradual resolution of symptoms was noted during the hospitalization, and BCVA in her RE was established at 0.7 at the 10-week follow-up.
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Affiliation(s)
| | - Mihnea Munteanu
- Department of Ophthalmology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Nadina Mercea
- Ophthalmology Clinic, Municipal Clinical Emergency Hospital, 300254 Timisoara, Romania
| | - Alina Moatar
- Ophthalmology Clinic, Municipal Clinical Emergency Hospital, 300254 Timisoara, Romania
| | - Horia Stanca
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florina Georgeta Popescu
- Department of Occupational Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Horațiu Dura
- Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania
| | - Adrian Hașegan
- Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania
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12
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Elsaadawy A, Panchasara B, Yadav A. Right Superior Ophthalmic Vein Thrombosis Induced by Pansinusitis. Cureus 2023; 15:e34857. [PMID: 36923170 PMCID: PMC10010152 DOI: 10.7759/cureus.34857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Superior ophthalmic vein thrombosis (SOVT) is a rare, sight-threatening condition. It can be clinically challenging to distinguish from pre-septal cellulitis or cavernous sinus thrombosis. Imaging is often a key to identifying SOVT, and multi-disciplinary input is paramount to ensuring the optimum outcome. This often involves the paediatricians, ophthalmologists and paediatric neurologists if necessary. We report a case of a young boy with right SOVT that had initially been diagnosed as pre-septal cellulitis. A contrast-enhanced computed tomography scan was performed, as the patient developed limited eye movement on elevation, which showed dilatation of the right ophthalmic vein with pansinusitis. He was successfully treated with anticoagulation and antibiotics.
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Affiliation(s)
- Ahmed Elsaadawy
- Department of Psychiatry, Fairfield General Hospital, Bury, GBR
| | - Binita Panchasara
- Department of Ophthalmology, West Suffolk Hospital, Bury St Edmunds, GBR
| | - Abhijeet Yadav
- Department of Ophthalmology, West Suffolk Hospital, Bury St Edmunds, GBR
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13
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Lavigne A, Horion J, Malandain E. Exophtalmie et ophtalmoplégie aiguës révélant une thrombose bilatérale des veines ophtalmiques supérieures. J Fr Ophtalmol 2022; 45:e369-e370. [DOI: 10.1016/j.jfo.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/06/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
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14
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Romano N, Urru A, Sasso R, Castaldi A. Imaging of superior ophthalmic vein: A pictorial overview. Clin Imaging 2022; 89:136-146. [DOI: 10.1016/j.clinimag.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
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Ray H, Megalla M, Linderman W, Habib L. Septic Superior Ophthalmic Vein Thrombosis in a Prothrombotic Adolescent Patient. Ophthalmic Plast Reconstr Surg 2022; 38:e57-e59. [PMID: 34812180 DOI: 10.1097/iop.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 14-year-old boy presented to the emergency room with 5 days of fever and periorbital edema and erythema refractory to 4 days of augmentin and clindamycin. Examination revealed normal visual acuity, mild left periorbital edema and erythema, and a (-)1 supraduction deficit, concerning for orbital cellulitis. CT imaging revealed pansinusitis, orbital cellulitis with subtle orbital fat stranding, and a dilated superior ophthalmic vein with concern for thrombosis. This was confirmed on subsequent magnetic resonance venography. He was treated with intravenous antibiotics and enoxaparin with significant improvement in 24 hours. Standard hypercoagulable workup revealed positive lupus anticoagulant and cardiolipin of unclear significance; on genetic sequencing, he was found to have a homozygous mutation of the 4G variant of plasminogen activator inhibitor-1. Plasminogen activator inhibitor-1 homozygosity is a rare predisposing hypercoagulable state. This case highlights the importance of hematologic and genetic studies in adolescent patients with superior ophthalmic vein thrombosis, particularly those with mild presentation.
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Affiliation(s)
- Hetal Ray
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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16
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Superior Ophthalmic Vein Embolism Following Forehead Augmentation with Autologous Fat Injection. Aesthetic Plast Surg 2022; 46:450-455. [PMID: 34231025 PMCID: PMC8831366 DOI: 10.1007/s00266-021-02414-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/05/2021] [Indexed: 11/06/2022]
Abstract
Background Facial rejuvenation and reconstruction with autologous fat injection are a common and effective procedure used worldwide. Most surgeons and patients are satisfied with the favorable outcomes. However, catastrophic complications from arterial and venous occlusion resulting in visual loss and stroke may occur. Case presentation We herein report a case of isolated venous occlusion from fat embolism. The patient developed acute painful proptosis and blurred vision of her right eye while undergoing an esthetic autologous fat injection into her forehead. Based on her clinical manifestations and radiologic findings, the patient was diagnosed with superior ophthalmic vein occlusion. Symptomatic and supportive treatments were given. Spontaneous clinical improvement occurred without secondary complications. Therefore, the initially planned endovascular therapy with transfemoral transvenous embolectomy of the right superior ophthalmic vein was canceled. Conclusions Facial augmentation with autologous fat injection can cause superior ophthalmic vein embolism. Surgeons should therefore perform this procedure very cautiously. Prompt ophthalmological evaluation and proper management are important for improving clinical outcomes. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Kreuzpointner R, Valerio L, Corsi G, Zane F, Sacco C, Holm K, Righini C, Pecci A, Zweifel S, Barco S. Ophthalmic complications of Lemierre syndrome. Acta Ophthalmol 2022; 100:e314-e320. [PMID: 33829646 DOI: 10.1111/aos.14871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. METHODS We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). RESULTS Nine (33%) patients were women; the median age was 20 (Q1-Q3: 15-33) years. Fusobacterium spp. was involved in 56% of cases. The most prevalent initial manifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nerve palsy (28%) and proptosis (28%). Venous involvement, notably cerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. CONCLUSION Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists.
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Affiliation(s)
| | - Luca Valerio
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
| | - Gabriele Corsi
- Department of Clinical, Integrated and Experimental Medicine (DIMES) Alma Mater Studiorum University of Bologna Bologna Italy
- Department of Pneumology and Respiratory Intensive Therapy Unit St Orsola University Hospital Bologna Italy
| | - Federica Zane
- Department of General Medicine Hospital of Sondrio Sondrio Italy
| | - Clara Sacco
- Thrombosis and Haemorrhagic Diseases Center Humanitas Clinical and Research Center‐IRCCS Milan Italy
| | - Karin Holm
- Department of Clinical Sciences Division of Infection Medicine Skåne University Hospital Lund University Lund Sweden
| | - Christian Righini
- Department of ENT, Head and Neck Surgery University Hospital of Grenoble Grenoble France
| | - Alessandro Pecci
- Department of Internal Medicine IRCCS Policlinico San Matteo Foundation and University of Pavia Pavia Italy
| | - Sandrine Zweifel
- Department of Ophthalmology University Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
| | - Stefano Barco
- Clinic of Angiology University Hospital Zurich Zurich Switzerland
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
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18
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Chen L, Guo US, Grutman G, McFarlane SI, Mehta P. Superior Ophthalmic Vein Thrombosis Induced by Orbital Cellulitis: An Ophthalmic Emergency. Cureus 2021; 13:e19038. [PMID: 34853755 PMCID: PMC8608043 DOI: 10.7759/cureus.19038] [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: 09/25/2021] [Accepted: 10/24/2021] [Indexed: 11/05/2022] Open
Abstract
Superior ophthalmic vein thrombosis (SOVT) is a rare ophthalmologic emergency. The most common etiologies include infection, trauma, inflammation, and malignancy, as well as thyroid-related orbitopathy. Early identification and timely intervention can lead to a significant decrease in complications that include cavernous sinus thrombosis (CST), vision loss, and death. This rare disease entity almost always makes its initial presentation to internal medicine or emergency medicine (EM) physicians. In this report, we present a case of SOVT that presented overnight to the emergency department for worsening right facial swelling and orbital pain. We discuss our experience with the evaluation and management of SOVT and provide a review of the currently available literature to emphasize the importance of obtaining a full history and physical examination, seeking early imaging studies, and ophthalmology consultation for patients with suspected SOVT.
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Affiliation(s)
- Lu Chen
- Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Uta S Guo
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Gennadiy Grutman
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Samy I McFarlane
- Department of Medicine and Endocrinology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Parag Mehta
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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19
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Rosa F, Renzetti P, Castellan L, Roccatagliata L. Cavernous sinus thrombosis associated with intraparenchymal hemorrhage and brainstem venous infarction as a rare complication of fronto-orbital infection. Neurol Sci 2021; 43:731-734. [PMID: 34664179 DOI: 10.1007/s10072-021-05658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- F Rosa
- Diagnostic Imaging Department, San Paolo Hospital- ASL 2, via Genova 30, Savona, Italy.
| | - P Renzetti
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - L Castellan
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - L Roccatagliata
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy.
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20
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21
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Khurram R, Naidu V, Butt MF, Durnford L, Joffe M. Superior ophthalmic vein thrombosis secondary to COVID-19: an index case. Radiol Case Rep 2021; 16:1138-1143. [PMID: 33688386 PMCID: PMC7927642 DOI: 10.1016/j.radcr.2021.02.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 01/03/2023] Open
Abstract
Superior ophthalmic vein thrombosis is a very rare condition, known to have a profound negative impact on vision and eye movement function and is usually associated with orbital infections, inflammation, tumors, or carotid cavernous fistulae. There is an increased risk of arterial and venous thrombosis associated with COVID-19, the presence of which is related to a significantly increased risk of mortality. We report an index case of superior ophthalmic vein thrombosis in a 61-year-old male patient who was diagnosed with COVID-19 pneumonitis and a concomitant saddle pulmonary embolus. He was swiftly treated with low molecular weight heparin which led to the resolution of the thrombosis within 3 weeks. This case highlights the importance of considering this entity in the context of COVID-19 as well as providing prompt treatment to reduce the risk of complications.
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Affiliation(s)
- Ruhaid Khurram
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Vishnu Naidu
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Mohsin F. Butt
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Luke Durnford
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Michael Joffe
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
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22
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Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: A review. Surv Ophthalmol 2021; 66:1021-1030. [PMID: 33831391 DOI: 10.1016/j.survophthal.2021.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
Septic cavernous sinus thrombosis (SCST) is a rare, yet severe, process typically arising from infections of the paranasal sinuses (predominately ethmoid and/or sphenoid sinusitis) and less commonly, otogenic, odontogenic, and pharyngeal sources. Clinical symptoms of SCST arise from obstruction of venous drainage from the orbit and compression of the cranial nerves within the cavernous sinus. In the preantibiotic era SCST was considered universally fatal (80-100%); however, with the introduction of antibiotics the overall incidence, morbidity, and mortality of SCST have greatly declined. In spite of dramatic improvements, morbidity and mortality remain high, with the majority of patients experiencing neurological sequalae, highlighting the severity of the disease and the need for prompt recognition, diagnosis, and treatment. Here we review of the literature on SCST with a focus on the current recommendations and recent evidence for diagnostic and medical management of this condition.
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Affiliation(s)
- Jonathan T Caranfa
- Department of Ophthalmology, New England Eye Center Tufts University School of Medicine, Boston, Massachusetts, USA; Eastern Connecticut Health Network, Manchester Memorial Hospital, Manchester, Connecticut, USA.
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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23
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Salim S, Koka K, Halbe S, Nisar SP, Singh P, Mukherjee B. Superior ophthalmic vein thrombosis post manual carotid compression for indirect carotid-cavernous fistula. Orbit 2020; 40:513-517. [PMID: 33032482 DOI: 10.1080/01676830.2020.1829650] [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: 10/23/2022]
Abstract
PURPOSE To report 5 cases of superior ophthalmic vein thrombosis (SOVT) following intermittent manual carotid compression (IMCC) for indirect carotid-cavernous fistula (CCF) and to outline the management. METHODS Retrospective observational case series of all patients who developed SOVT secondary to IMCC for indirect low flow CCF's at a tertiary care center. The demographic profile, clinical, imaging findings, treatment, and outcomes were studied. RESULTS The mean age at presentation was 60.2 years (Range: 42-87 years). Four patients were male. All patients had a unilateral presentation. The mean time interval between starting IMCC and the development of SOVT was 1.18 months (Range: 0.25-3 months). Acute exacerbation of proptosis and chemosis associated with a decrease in vision was the presenting feature in all the patients. The mean visual acuity at presentation was 0.89 on the logMAR scale. The causes of reduced visual acuity were venous stasis retinopathy (n = 4) and compressive optic neuropathy (n = 1). Magnetic resonance imaging revealed enlarged superior ophthalmic vein with absent flow voids and post-contrast filling defects. Four patients received anticoagulation treatment with subcutaneous injection of enoxaparin 1 mg/kg twice daily for 5 days followed by oral warfarin 5 mg once daily along with oral steroids. Complete recovery of SOVT was noted in all patients at a mean duration of treatment of 0. 75 months (Range: 0-2 months). CONCLUSION SOVT is a rare but possible complication in patients on IMCC for indirect CCF, and hence warrants close follow up. Early diagnosis and prompt management will help in preventing complications like permanent vision loss.
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Affiliation(s)
- Shebin Salim
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Kirthi Koka
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Swatee Halbe
- Department of Interventional Radiology, Apollo Speciality Hospitals, Vanagram, Chennai, India
| | - Sonam Poonam Nisar
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Parinita Singh
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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24
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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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25
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Shahlaee A, Hennein LM, Winn BJ, Dillon WP, Rasool N. Bilateral superior ophthalmic vein thrombosis associated with high altitude. Orbit 2020; 40:407-411. [PMID: 32727245 DOI: 10.1080/01676830.2020.1797825] [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: 10/23/2022]
Abstract
We report a case of a 47-year-old female who experienced periorbital swelling while descending from a Himalayan mountain climb and was found to have bilateral superior ophthalmic vein thromboses (SOVT). Infectious, autoimmune, and hypercoagulability work-up were negative with no cavernous sinus involvement. Symptoms resolved upon initiation of anticoagulation and oral steroids. SOVT is a rare but serious condition and has a risk of extending into the cavernous sinus if not treated early. Although infection is the most common etiology, venous thrombosis can be precipitated under high altitude and low oxygen pressure environments. We present a case of superior ophthalmic vein thrombosis associated with high-altitude conditions.
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Affiliation(s)
- Abtin Shahlaee
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Lauren M Hennein
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Nailyn Rasool
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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26
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Ekeh L, Dermarkarian CR, Foroozan R, Bhatti MT. A shotgun wedding. Surv Ophthalmol 2020; 66:668-673. [PMID: 32628947 DOI: 10.1016/j.survophthal.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
A 69-year-old woman developed a carotid-cavernous fistula (CCF) after firing a shotgun. Initially, the patient had mild visual symptoms, but later on developed prominent features of CCF including chemosis, proptosis, ophthalmoparesis and conjunctival injection . The fistula was embolized via an intravascular coiling procedure. We are unaware of another patient who developed a CCF due to blunt force from shotgun use.
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Affiliation(s)
- Leroy Ekeh
- Cullen Eye Institute. Baylor College of Medicine. Houston, Texas
| | | | - Rod Foroozan
- Cullen Eye Institute. Baylor College of Medicine. Houston, Texas.
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27
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Magnetic resonance imaging of intraocular optic nerve disorders: review article. Pol J Radiol 2020; 85:e67-e81. [PMID: 32467740 PMCID: PMC7247023 DOI: 10.5114/pjr.2020.93364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/25/2020] [Indexed: 01/04/2023] Open
Abstract
The optic nerve is morphologically classified as a peripheral nerve, but histologically it shares characteristics with the central nerves. Diseases that affect vision and the optic nerve are many and varied: optic neuritis, demyelination (multiple sclerosis, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-related disorders), drugs, collagen disease, vasculitis, infection, trauma, vascular abnormalities, tumours, and non-tumoural masses. In this review, we summarise the magnetic resonance imaging findings for various pathological conditions that cause deterioration in visual acuity.
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28
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Choi JH, Samara WA, Pflugrath AE, Benson WH. Painful Proptosis in a 12-Year-Old Boy. J Pediatr Ophthalmol Strabismus 2020; 57:204. [PMID: 32453855 DOI: 10.3928/01913913-20200115-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Bhatia H, Kaur R, Bedi R. MR imaging of cavernous sinus thrombosis. Eur J Radiol Open 2020; 7:100226. [PMID: 32154332 PMCID: PMC7057197 DOI: 10.1016/j.ejro.2020.100226] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/11/2020] [Accepted: 02/22/2020] [Indexed: 11/27/2022] Open
Abstract
Quantitative & qualitative parameters on CEMRI are essential for diagnosis of CST. Enlarged sinus, compressed cavernous ICA & dilated SOV should raise a suspicion. Heterogenous signal intensity of the sinus on plain MRI should prompt evaluation. Bulging lateral walls with abnormal dural enhancement & filling defects are good predictors. Filling defects on post contrast images & orbital apex involvement are also seen.
Purpose To determine the role of Contrast enhanced MRI (CEMRI) in the evaluation of Cavernous sinus thrombosis (CST). Method The study included 7 patients with an imaging diagnosis of cavernous sinus thrombosis. A retrospective analysis of Contrast enhanced MRI of 9 affected cavernous sinuses and a control group of 7 patients (14 cavernous sinuses) was conducted. Various qualitative and quantitative parameters were then compared. Results In the patient group, the mean Cavernous sinus (CS) diameter, Cavernous Internal Carotid Artery (ICA) diameter and Superior Ophthalmic Vein (SOV) diameter were 9.14 ± 0.56 mm, 3.5 mm ± 0.9 mm and 3.8 mm ± 1.79 mm respectively. While in the control group, the mean CS diameter, ICA diameter and SOV dimeter were 6.58 ± 0.54 mm, 4.6 mm ± 0.44 mm and 1.1 mm ± 0.11 mm respectively. The differences in the CS size, ICA and SOV diameters was statistically significant. (p < 0.05). Cut off points of ≥ 10 mm for CS diameter, ≥ 2.9 mm for SOV dilation, and ≤ 4.2 mm for ICA flow void diameter were estimated using receiver operating characteristic curves. Various other qualitative parameters, like bulging lateral walls of the sinus, heterogenous signal intensity with filling defects on post contrast images, abnormal dural enhancement along the lateral wall of the sinus and orbital apex involvement were more frequently observed in the CST group, in comparison to the control group. Conclusions CEMRI plays an invaluable role not only in the diagnosis of cavernous sinus thrombosis, but also in evaluating the extent of disease and its associated complications. The quantitative and qualitative parameters described here, provide more objectivity and accuracy in diagnosis of CST, thus, aiding prompt diagnosis and early treatment.
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Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Ravinder Kaur
- Department of Radiodiagnosis Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Raveena Bedi
- Department of Radiodiagnosis Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
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