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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] [What about the content of this article? (0)] [Affiliation(s)] [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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2
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Guarnizo A, Rugilo C. Gradenigo's syndrome associated to internal carotid artery vasculitis. Acta Neurol Belg 2023:10.1007/s13760-023-02408-6. [PMID: 37945802 DOI: 10.1007/s13760-023-02408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Angela Guarnizo
- Department of Radiology, Division of Neuroradiology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 # 117-15, Bogotá, Colombia.
| | - Carlos Rugilo
- Department of Radiology, Division of Neuroradiology, Hospital de Pediatría J. P. Garrahan, Combate de los Pozos 1881, (C 1245 AAM), Buenos Aires, Argentina
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3
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Sultania M, Das Majumdar SK, Raghuram K, Ganapathy A. A rare case of cavernous sinus thrombosis following oral squamous cell carcinoma - The etiology and management dilemma. Oral Oncol 2023; 142:106421. [PMID: 37216834 DOI: 10.1016/j.oraloncology.2023.106421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 05/24/2023]
Abstract
Intracranial cavernous sinus metastases of oral squamous cell carcinoma (OSCC) are rare, with a reported incidence of 0.4 %. Due to their extremely infrequent presentation the etiology and management modalities of such complications are not clearly represented in the literature. Here we present a case of a 58-year-old male diagnosed with OSCC of Right Lower Alveolus with underlying bone invasion, cT4aN1M0, Stage IV. He underwent Right Hemi-mandibulectomy with Modified Neck Dissection, Pectoralis Major Myocutaneous Flap, and 60 Gy/30# adjuvant radiotherapy. Six months later, the patient was diagnosed with recurrence involving the right infratemporal fossa with associated right cavernous sinus thrombosis. Immunohistochemistry block review showed PDL1 - Positive. The patient was subjected to Cisplatin and Pembrolizumab immunotherapy. After receiving 35 cycles of Pembrolizumab over a period of 2 years the patient is doing well with no recurrence.
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Affiliation(s)
- Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - K Raghuram
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Arthi Ganapathy
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
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4
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Parveen N, Singh S, Mishra S. Foramen venosum: a clinicoanatomic insight into its occurrence and morphometry. Surg Radiol Anat 2023; 45:409-415. [PMID: 36811687 DOI: 10.1007/s00276-023-03106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The present study aimed to evaluate the foramen venosum (FV) frequency, incidence, morphometry and relation with foramen ovale in an Indian population. The emissary vein passing through it may spread extracranial facial infections to the intracranial cavernous sinus. Due to its close proximity with the foramen ovale and its variable occurrence, awareness about its presence and anatomy is essential to neurosurgeons operating in this region. METHODS 62 dry adult human skulls were studied for the occurrence and morphometry of foramen venosum, both at the middle cranial fossa and extracranial base of the skull. Dimensions were taken using Java-based image processing program, IMAGE J. After collection of data, appropriate statistical analysis was done. RESULTS The foramen venosum was observed in 49.1% skulls. Its presence was noted more frequently at the extracranial skull base than in the middle cranial fossa. No significant difference was observed between the two sides. FV at the extracranial view of the skull base had a larger maximum diameter than in the middle cranial fossa; however, the distance between FV and the foramen ovale was found to be more at the middle cranial fossa than at the extracranial view of the skull base on both the right and left side. Variations in the shape of the foramen venosum were also observed. CONCLUSION The present study is not only of great importance to anatomists, but also to radiologists and neurosurgeons for better planning and execution of the surgical approach to the middle cranial fossa through the foramen ovale to prevent iatrogenic injuries.
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Kumar A, Gupta K, Tyagi AK, Varshney S, Kumar N. Isolated Acute Sphenoid Fungal Sinusitis with Cavernous Sinus Thrombosis: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:987-993. [PMID: 36452689 PMCID: PMC9701963 DOI: 10.1007/s12070-020-02059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022] Open
Abstract
Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite non-conclusive imaging, is warranted as early intervention may significantly impact the chances of survival. "Time is vision" in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. "time is muscle.
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Affiliation(s)
- Amit Kumar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Kartikesh Gupta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Saurabh Varshney
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Niraj Kumar
- Department of Neurology, All India Institue of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
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6
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Grillo R, Borba AM, Brozoski M, Moreira SB, da Silva YS, da Graça Naclério-Homem M. Evolution of the treatment of severe odontogenic infections over 50 years: A comprehensive review. J Taibah Univ Med Sci 2023; 18:225-33. [PMID: 36817218 DOI: 10.1016/j.jtumed.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Severe odontogenic infections remain a challenge for maxillofacial surgeons. The aim of this work is to review the literature to provide an update of knowledge on the topic. Methods A comprehensive review of articles in PubMed, Web of Science and Africa Journals Online was performed through searching for "severe odontogenic infections." No language restrictions were applied. Only articles pertaining to treatment options were retrieved. Articles from the past 50 years were included. Results A total of 84 articles from 39 countries worldwide were included. Severe odontogenic infections are not unique to low- and middle-income countries but also pose challenges in developed countries. Surgical management and antibiotic therapy for this type of infection is discussed. Some immunocompromised patients have high risks of complications and mortality rates. A world map of publications on the topic is provided. Conclusions Several important aspects of managing severe odontogenic infections are discussed. Predictors of severity in addition to recommended antibiotic choice have been debated. Diabetes mellitus is a poor predictor of the prognosis of odontogenic infections.
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Lawrence AS, Stoddard DG, Czyz CN, Richardson TE, Michels KS. Orbital cellulitis and cavernous sinus thrombosis with contralateral sinus disease in a COVID-19 positive adolescent patient. Orbit 2021; 42:332-335. [PMID: 34847834 DOI: 10.1080/01676830.2021.2006722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with COVID-19 have been reported to have elevated coagulation factors, which is a well-documented cause of venous thromboembolism events such as deep vein thrombosis and pulmonary embolism. Other venous thrombotic events, however, such as cavernous sinus thrombosis (CST) have been less commonly observed, specifically in combination with primary orbital cellulitis. Due to its unique anatomic location, the cavernous sinus is susceptible to thrombophlebitis processes including septic thrombosis and thrombosis most commonly from sinusitis. Many studies have shown that in the antibiotic era thromboembolic events of the cavernous sinus are less common due to infection spread from the orbit or facial region. This case report describes a 17-year-old COVID-19 positive male who presented with a left-sided primary orbital cellulitis with CST without radiographic evidence of ipsilateral sinus disease.
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Affiliation(s)
- Amelia S Lawrence
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - David G Stoddard
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA.,Department of Otorhinolaryngology, Columbia Surgical Specialists, Spokane, Washington, USA
| | - Craig N Czyz
- Section Oculofacial Plastic & Reconstructive Surgery, Ohio University/Ohio Health, Columbus, Ohio, USA
| | - Thomas E Richardson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Kevin S Michels
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA.,Department of Ophthalmology, Northwest Eyelid and Orbital Specialists, PS, Spokane, Washington, USA
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8
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Shin JS, Dayton OL, Albayram MS. Streptococcus Intermedius as the cause of sphenoid sinusitis & associated extensive skull base and neck thrombophlebitis & thrombosis. Clin Imaging 2021; 81:103-106. [PMID: 34695722 DOI: 10.1016/j.clinimag.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/24/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Acute bacterial sinusitis may be complicated by orbital and intracranial involvement and by thrombophlebitis. Its spread across multiple anatomic compartments is facilitated by the interconnected venous anatomy of the head and neck and the virulence of the primary pathogen. We present a rare case of Streptococcus Intermedius (S. Intermedius) acute bacterial sinusitis complicated by extensive skull base involvement including cavernous sinuses and neck vein thrombophlebitis and thrombosis.
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Affiliation(s)
- Joon Soo Shin
- University of Florida College of Medicine, Department of Radiology, 1600 SW Archer Road, Gainesville, FL 32610, USA.
| | - Orrin L Dayton
- University of Florida College of Medicine, Department of Radiology, 1600 SW Archer Road, Gainesville, FL 32610, USA.
| | - Mehmet S Albayram
- University of Florida College of Medicine, Department of Radiology, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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9
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Kaushik KS, Ananthasivan R, Acharya UV, Rawat S, Patil UD, Shankar B, Jose A. Spectrum of intracranial complications of rhino-orbito-cerebral mucormycosis - resurgence in the era of COVID-19 pandemic: a pictorial essay. Emerg Radiol 2021; 28:1097-1106. [PMID: 34605991 PMCID: PMC8488318 DOI: 10.1007/s10140-021-01987-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022]
Abstract
Rhino-orbito-cerebral mucormycosis (ROCM) has regained significance following its resurgence in the second wave of the COVID-19 pandemic in India. Rapid and progressive intracranial spread occurs either by direct extension across the neural foraminae, cribriform plate/ethmoid, walls of sinuses, or angioinvasion. Having known to have a high mortality rate, especially with intracranial extension of disease, it becomes imperative to familiarise oneself with its imaging features. MRI is the imaging modality of choice. This pictorial essay aims to depict and detail the various intracranial complications of mucormycosis and to serve as a broad checklist of structures and pathologies that must be looked for in a known or suspected case of ROCM.
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Affiliation(s)
- Kavya S Kaushik
- Department of Radiology, Manipal Hospitals, 98, HAL Old Airport Road, Kodihalli, Bengaluru, 560017, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospitals, 98, HAL Old Airport Road, Kodihalli, Bengaluru, 560017, India.
| | - Ullas V Acharya
- Department of Radiology, Manipal Hospitals, 98, HAL Old Airport Road, Kodihalli, Bengaluru, 560017, India
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospitals, 98, HAL Old Airport Road, Kodihalli, Bengaluru, 560017, India
| | - Uday Damodar Patil
- Department of Radiology, Manipal Hospitals, 98, HAL Old Airport Road, Kodihalli, Bengaluru, 560017, India
| | - Balasubramanyam Shankar
- Department of Radiology, Manipal Hospitals, 98, HAL Old Airport Road, Kodihalli, Bengaluru, 560017, India
| | - Abin Jose
- Department of Radiology, Manipal Hospitals, 98, HAL Old Airport Road, Kodihalli, Bengaluru, 560017, India
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10
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Roushdy T, Hamid E. A case series of post COVID-19 mucormycosis-a neurological prospective. Egypt J Neurol Psychiatr Neurosurg 2021; 57:100. [PMID: 34335016 PMCID: PMC8312207 DOI: 10.1186/s41983-021-00355-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Direct neurological manifestations of coronavirus disease whether peripheral or central are reported worldwide. Yet, along the 3rd wave of the pandemic especially in India, an associated angioinvasive opportunistic infection with mucormycosis in COVID-19 cases is emerging. Case presentation The current case series which represents 4 patients with mucormycosis post COVID-19 is one of a few if not the first case series that discusses post COVID-19 mucormycosis from a neurological prospective in a tertiary hospital in Egypt. All cases but one presented with total ophthalmoplegia, and only one was diagnosed as a cavernous sinus thrombosis; meanwhile, orbital cellulitis and orbital apex syndrome were responsible of ophthalmoplegia in two cases. Mortality reached 25%, and the case that died suffered cutaneous as well as rhino-cerebral type with a delayed presentation to hospital. Conclusion A rare but fatal fungal infection is ought to be nowadays kept in mind in COVID-19 active cases as well as in recovered COVID-19 patients, especially those who have comorbid medical conditions as uncontrolled diabetes and who were treated with large doses of corticosteroids.
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Affiliation(s)
- Tamer Roushdy
- Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Eman Hamid
- Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
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11
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Eswaran S, Balan SK, Saravanam PK. Acute Fulminant Mucormycosis Triggered by Covid 19 Infection in a Young Patient. Indian J Otolaryngol Head Neck Surg 2021; 74:3442-3446. [PMID: 34258246 PMCID: PMC8265298 DOI: 10.1007/s12070-021-02689-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022] Open
Abstract
Covid 19 infection can result in various opportunistic infections. Altered immune response, associated comorbid conditions like diabetes, prolonged steroid and broad spectrum antibiotics usage with ICU interventions lead to increased chance of such superadded infections in covid 19 patients. Here we report a case of 31 year old male with covid 19 infection who had new onset Diabetes Mellitus, developed severe acute fulminant Mucormycosis during the treatment for covid 19 infection. He presented with severe headache, nasal obstruction and discharge, bilateral ophthalmoplegia and blindness with Cavernous Sinus Thrombosis. Patient underwent aggressive surgical debridement with frontal craniectomy, maxillectomy and right orbital evisceration and left endoscopic orbital decompression and judicious efforts to revert back the immunocompromised status with high dose of Liposomal amphotericin. Post operatively patient developed right temporal lobe abscess which was drained through Endonasal Endoscopic Trans Cavernous drainage of Temporal Lobe Abscess. Patient is in 2 months follow up, with bilateral blindness and tolerating oral feeds with improved left eye ophthalmoplegia. It is imperative to note that the rising trend of mucormycosis is there in Covid 19 infections and it should be dealt with high index of suspicion in high risk patients and early aggressive treatment can save the patient as the survival rate is not high in such infections.
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Affiliation(s)
- Sudhagar Eswaran
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sarath Kumar Balan
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Prasanna Kumar Saravanam
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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12
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Abstract
Coronavirus disease-2019 (COVID-19) is showing a wide spectrum of ocular manifestations. They are creeping from vision sparing to irreversible visual loss as a result of its thromboembolic events. Hypercoagulability associated with COVID-19 is also called “sepsis-induced coagulopathy” and may predispose to thromboembolic phenomenon that decides the morbidity and mortality of this pandemic. A 37-year-old man presented with no perception of light in the left eye with optic atrophy and macular pucker on fundus examination. Visual evoked potential showed extinguished P 100 wave. His past medical history revealed severe pneumonia secondary to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV 2) infection about 3 months back.
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Affiliation(s)
- Anuradha Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Navjot Kaur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Navdeep Kaur
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Singh P, Arora S, Mittal N, Singh A, Verma R, Sharma S, Agrawal NK, Goyal S. Diabetes and rhino-orbito-cerebral mucormycosis - A deadly duo. J Diabetes Metab Disord 2021; 20:201-7. [PMID: 34222064 DOI: 10.1007/s40200-021-00730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/20/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
Background Rhino-orbito-cerebral mucormycosis(ROCM) is an uncommon yet potentially fatal fungal infection predominantly seen in immunocompromised individuals. However, there is very limited data available from India regarding outcome of patients with ROCM and diabetes mellitus. Objective To ascertain clinical parameters and factors in the final outcome of patients with diabetes mellitus and ROCM. Materials and Methods This series included retrospective analysis of medical records of 91 patients with diabetes mellitus who were diagnosed with ROCM from january 2007 to june 2019 at a tertiary care hospital in Punjab. Results The mean age of patients was 52.6 years (range 18-82 years), with men constituting the majority (71.4 %). Ophthalmoplegia was the most frequent presenting feature seen in 77 % of patients followed by proptosis (71 %). Intracranial involvement was seen in 20 % of the patients and cavernous sinus thrombosis was diagnosed in 9(10 %) patients. Out of 91 patients, 81 patients were subjected to appropriate surgical procedure depending upon site and extent of involvement by mucorales. A total of 53 (58.2 %) patients survived while 38(41.8 %) patients succumbed. Delay in presentation to hospital, intracranial extension and loss of vision at presentation adversely affected the outcome (p < 0.05). Aggressive surgical management in the form of multiple debridements was superior to single debridement (p < 0.05). Diabetic ketoacidosis did not significantly affect the outcome (p = 0.359). Conclusions ROCM in patients with diabetes mellitus, is a rapidly progressive disease with a high fatality rate and grave outcome unless diagnosed early and managed aggressively.
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15
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Aloua R, Kerdoud O, Slimani F. Cavernous Sinus Thrombosis related to Orbital Cellulitis Serious Complication to Prevent: a case report and literature review. Ann Med Surg (Lond) 2021; 62:179-181. [PMID: 33532066 PMCID: PMC7829077 DOI: 10.1016/j.amsu.2021.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The authors report a case which aims to underline the importance of multidisciplinary management and rapid diagnosis of orbital cellulitis, for an adequate treatment of ocular damages and related complications, to prevent serious and permanent sequelae and avoid a fatal prognosis. Presentation of case A 61-year-old female reported to the oral and maxillofacial surgery department after she was dragged around for two months. She presented with a right facial swelling and orbital apex syndrome including proptosis, ophthalmoplegia and ptosis. Discussion Complications of orbital cellulitis may be limited to the orbit, such as subperiosteal or orbital abscess, optic neuritis, blindness, or intracranial such as meningitis, sinus cavernous thrombosis, cerebral abscess and even death. Conclusion Maxillofacial surgeons must be aware of this complication in a multidisciplinary context to adopt adequate treatment as soon as possible. Orbital cellulitis is a rare ophthalmic disease due to pansinusitis with hard maxillofacial management. Cavernous sinus thrombosis is a rare but highly fatal complication of orbital cellulitis. Early and appropriate treatment can improve the bad prognosis of this condition and avoid visual sequelae. Maxillofacial surgeons must be aware of this complication in a multidisciplinary context to adopt adequate treatment as soon as possible.
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Affiliation(s)
- Rachid Aloua
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Ouassime Kerdoud
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Faiçal Slimani
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco.,Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
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16
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Gupta J, Chakrabarty B, Singh G, Singh S, Kumar A, Xess I, Jauhari P, Gulati S. A rare infective cause of stroke in an immunocompetent child. Brain Dev 2021; 43:152-6. [PMID: 32855000 DOI: 10.1016/j.braindev.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Infections are a common cause of childhood stroke with variable presentation. The current case describes a rare infective cause of venous and arterial stroke in an immunocompetent girl with management implications. CASE DESCRIPTION A 12 year old girl, presented with history of fever for 10 days, painful swelling of right eye for 7 days and altered sensorium for 2 days. On examination, she had right eye orbital cellulitis and fullness of right paranasal area. On nervous system examination, she was delirious, had right eye ophthalmoparesis, left upper motor neuron facial palsy and signs of meningeal inflammation. Her contrast enhanced CT head and subsequent MRI brain with arteriography and venography revealed right cavernous sinus and distal internal carotid artery thrombosis. She was started on intravenous ceftriaxone and vancomycin and subcutaneous heparin. In view of persistent symptoms, endoscopic debridement of right nasal cavity was done, which showed growth of aspergillus flavus. Subsequently, she was started on intravenous voriconazole. Within a week, she was afebrile, her inflammatory and neurological signs started improving. She was discharged after 3 weeks of intravenous voriconazole which was continued for 3 more weeks orally. Her procoagulant and immunodeficiency work up were normal. At 4 months follow up, she showed both clinical and radiological resolution. CONCLUSIONS Despite high mortality described in sino-orbital aspergillosis, early and appropriate treatment led to optimal outcome. In deep seated infections, isolation of etiological organism should be attempted, particularly when patient doesn't respond to conventional antimicrobial therapy.
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Geng B, Wu X, Malhotra A. Septic cavernous sinus thrombosis-Case series and review of the literature. Clin Neurol Neurosurg 2020; 197:106092. [PMID: 32693341 DOI: 10.1016/j.clineuro.2020.106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Septic cavernous sinus thrombosis (CST) is a rare, life-threatening disease with infectious thrombosis causing associated complications resulting in high morbidity and mortality. We report a series of CST patients with assessment of arterial and intracranial complications. METHODS We used the radiology database from a large, academic tertiary care center to collect all patients treated with CST between 2002 and 2019. Patient demographics, source of infection, treatment course and outcomes were evaluated. A review of the recent literature was also performed for similar reported complications from CST. RESULTS 14 patients with CST treated during this time period were assessed. Of the 14 patients, 1 patient died. 7 patients had unilateral narrowing of ICA while 3 patients had bilateral narrowing. The ICA narrowing was reversible in 10/12 patients and improvement but persistent narrowing in one patient. One patient had an infectious pseudo aneurysm that was treated by coiling. Extension of thrombosis to the transverse- sigmoid sinuses and internal jugular vein were seen in 3 patients. Three patients had subdural empyema which was treated surgically. CONCLUSION The prognosis of CST has improved with advancement in treatment, but complications are not infrequent.
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Affiliation(s)
- Bertie Geng
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, United States.
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, United States.
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042, United States.
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18
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Smith SM, Thelen JC, Bhatt AA, Kessler AT. Facial swelling for the emergency radiologist-typical and atypical causes. Emerg Radiol 2020; 28:177-183. [PMID: 32556655 DOI: 10.1007/s10140-020-01809-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/12/2020] [Indexed: 12/01/2022]
Abstract
There are a wide variety of inflammatory, infectious, and cystic lesions which may lead patients to seek acute care for facial swelling. Computed tomography (CT) has become the mainstay for imaging in the urgent/emergent setting. However, magnetic resonance imaging (MRI) can also serve as a powerful problem solving tool in the modern era. As volume continues to increase, a wide variety of facial pathology will be encountered by the emergency radiologist. Recognition of both common and uncommon pathology will assist in diagnosis and value-based care. This article serves as an image-rich review of the many causes of facial swelling with an emphasis on key imaging findings and possible complications.
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Affiliation(s)
- Stephen M Smith
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA
| | - Jarett C Thelen
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Alexander T Kessler
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA.
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Lee JH, Heo HJ, Kim KM, Lee HG, Baek SM, Jung DW. Herpes zoster in the ophthalmic branch of the trigeminal ganglia obscuring cavernous sinus thrombosis due to Streptococcus constellatus subsp. constellatus - A case report. Anesth Pain Med (Seoul) 2020; 15:205-208. [PMID: 33329815 PMCID: PMC7713813 DOI: 10.17085/apm.2020.15.2.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background Herpes zoster ophthalmicus (HZO) is an infectious disease that results from the reactivation of latent varicella zoster virus in the ophthalmic branch of the trigeminal ganglia. HZO manifests with herpes zoster-like symptoms such as rash with or without signs of ocular involvement. Cavernous sinus thrombosis (CST) is a life-threatening condition accompanied by signs and symptoms involving the eyes and the cranial nerves. Case We report a case of septic cavernous sinus thrombosis (caused by Streptococcus constellatus subsp. constellatus) which was masked by the simultaneous occurrence of HZO in this patient, resulting in delayed diagnosis. Conclusions CST may be obscured by HZO, prompt diagnosis and treatment is necessary when such case arrive.
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Affiliation(s)
- Ji Hye Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Hyun Joo Heo
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ki Man Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Han Gyeol Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seung Min Baek
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Da Wa Jung
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
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20
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Rohowetz LJ, Gratton SM, Dansdill D, Miller CJ, Dubin S. Cavernous sinus thrombosis caused by Streptococcus constellatus-associated Lemierre syndrome presenting as an isolated abducens nerve palsy. Am J Ophthalmol Case Rep 2020; 18:100592. [PMID: 32123771 PMCID: PMC7037586 DOI: 10.1016/j.ajoc.2020.100592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe a patient with Streptococcus constellatus-associated Lemierre syndrome complicated by eventual cavernous sinus thrombosis (CST) that manifested as an isolated abducens nerve palsy. Observations A patient with a history of heavy alcohol use presented with Lemierre syndrome caused by an odontogenic infection due to Streptococcus constellatus. Despite initiation of intravenous antibiotics and eventual eradication of her bacteremia, she developed an isolated abducens nerve palsy on hospital day 7 due to associated CST. Conclusions and Importance CST is a rare complication of odontogenic infection and Lemierre syndrome. This case demonstrates the potential for primary odontogenic infections to progress to life- and sight-threatening diseases. This case also illustrates the importance of considering uncommon pathogens as the etiology of CST based on the suspected source of primary infection.
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Affiliation(s)
| | | | | | | | - Sarah Dubin
- Corresponding author. Department of Internal Medicine University of Missouri, Kansas City 2411 Holmes St, Kansas City, MO, 64108, USA.
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21
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Hsu CW, Tsai WC, Lien CY, Lee JJ, Chang WN. The clinical characteristics, implicated pathogens and therapeutic outcomes of culture-proven septic cavernous sinus thrombosis. J Clin Neurosci 2019; 68:111-116. [PMID: 31331748 DOI: 10.1016/j.jocn.2019.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
Abstract
In this magnetic resonance imaging-based study, we investigated the clinical features, neuroimaging features and therapeutic outcomes of 14 adults (eight men and six women; mean age 60.4 years; range 37-77 years) with septic cavernous sinus thrombosis (CST). Of the underlying conditions, 10 had diabetes mellitus and 13 had concomitant sphenoid sinusitis. Headache (n = 13) and ophthalmoplegia (n = 13) were the most common clinical presentations, followed by fever (n = 9) and other neuro-vascular signs and symptoms. The duration from the onset of symptoms to diagnosis ranged from 1 to 61 days, and more than 64% (9/14) of the septic CST patients were diagnosed >7 days after symptom onset. Expansion of the cavernous sinus was the most common neuroimaging feature, followed by convexity of the lateral wall of the cavernous sinus (5) and filling defect of the cavernous sinus (4). Staphylococcal species (spp.) was the most commonly implicated pathogen, followed by Aspergillus spp. Despite treatment, 7% (1/14) of the patients died in the hospital and 67% (8/12) of the survivors had neurological deficits. The duration of onset-to-diagnosis and the presence of hemiparesis were significant prognostic factors. These results provide a preliminary view of this uncommon infectious syndrome. Further large-scale studies are needed to better delineate septic CST in adults.
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Affiliation(s)
- Che-Wei Hsu
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wan-Chen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Yi Lien
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jun-Jun Lee
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Sotoudeh H, Shafaat O, Aboueldahab N, Vaphiades M, Sotoudeh E, Bernstock J. Superior ophthalmic vein thrombosis: What radiologist and clinician must know? Eur J Radiol Open 2019; 6:258-264. [PMID: 31641683 PMCID: PMC6796573 DOI: 10.1016/j.ejro.2019.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022] Open
Abstract
Incidental SOVT: good prognosis, self-limited and treated by anticoagulation. Post-traumatic and surgical SOVT: good prognosis, treated by anticoagulation. Septic SOVT: secondary to infections, high risk, requires specific interventions. Aseptic SOVT: secondary to inflammatory diseases, need to treat underlying etiology. CT and MRI are vital to the correct diagnosis and management of patients with SOVT.
Purpose Superior ophthalmic vein thrombosis (SOVT) is an extremely rare condition. Few studies have been published about clinical aspects of this condition. In this study, we have studied the symptoms, underlying etiologies, treatment, pathogenesis and complication of the SOVT and we tried to classify it based on the etiology, treatment, and prognosis. Methods We reviewed the patients’ data from a tertiary academic referral center. Each patient with SOVT was then reviewed for symptoms associated with SOVT, underlying etiology, treatment protocol, treatment response, complications, possible pathogens, and final outcome. Results Twenty-four cases of SOVT were included in this study. Overall, 13 cases were diagnosed as right-sided SOVT, out of which, eight had simultaneous right-sided cavernous sinus thrombosis (CST). Eighteen cases were diagnosed to have left-sided SOVT, out of which, 11 had simultaneous left-sided CST. Conclusions The SOVT can be secondary to different mechanisms. The SOVT secondary to trauma, recent surgery and coagulopathy are mostly non-aggressive, and can be managed by conservative therapy and anticoagulation. The SOVT in patients with orbital cellulitis, history of active sinusitis or paranasal sinus surgery are aggressive presenting with acute orbital swelling, abscess and visual loss. This type of SOVT can be complicated by extension to the cavernous sinus and intracranial structures. These patients require urgent antibiotics therapy and sinus surgery. The most severe type of SOVT is caused by mucormycosis which may also extend intracranially resulting in stroke and is often life-threatening.
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Key Words
- B/L, bilateral
- CCF, carotid cavernous fistula
- CST, cavernous sinus thrombosis
- CT, computed tomography
- Cavernous sinus thrombosis
- F, female
- IRB, institutional review board
- L, left
- M, male
- MRI, magnetic resonance Imaging
- N/A, not applicable
- Orbital cellulitis
- R, right
- RA, rheumatoid arthritis
- SCC, Squamous Cell Carcinoma
- SLE, systemic lupus erythematosus
- SOV, superior ophthalmic vein
- SOVT, superior ophthalmic vein thrombosis
- Sinusitis
- Superior ophthalmic vein thrombosis
- Thrombophlebitis
- UTI, Urinary Tract Infection
- Y, yes
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Affiliation(s)
- Houman Sotoudeh
- Department of Neuroradiology, University of Alabama at Birmingham (UAB), 619 19th St S, Birmingham, AL, 35294, JTN 333, USA
| | - Omid Shafaat
- Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, 8174675731 Alzahra Teaching Hospital, Sofeh Blvd, Isfahan, Iran
| | - Noha Aboueldahab
- Department of Neuroradiology, University of Alabama at Birmingham (UAB), 619 19th St S, Birmingham, AL 35294, USA
| | - Michael Vaphiades
- University of Alabama Birmingham (UAB) Department of Ophthalmology, 700 South 18th Street, Birmingham, AL 35233, USA
| | - Ehsan Sotoudeh
- Department of Surgery, Iranian Hospital in Dubai, P.O.BOX: 2330, Al-Wasl Road, Dubai 2330, United Arab Emirates
| | - Joshua Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building, 60 Fenwood Road, Boston, MA 02115, USA
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Shemesh A, Al-Shafai L, Krings T, Margolin E. When the Problem Became the Solution. Can J Neurol Sci 2019; 46:767-9. [PMID: 31270004 DOI: 10.1017/cjn.2019.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a unique case where a young man developed subtle cavernous sinus thrombosis (CST) due to underlying hypercoagulable state. He also had coexisting frontal lobe brain dural arteriovenous fistula (bdAVF). After CST developed, venous drainage from the optic nerve was redirected into the frontal lobe which was already under high venous pressure because of preexisting bdAVF. This caused backflow of venous blood into the optic nerve causing massive persistent optic nerve head swelling. Presumed acute venous hypertension event within bdAVF caused frontal mass effect presenting as seizure leading to thrombosis of bdAVF.
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Malincarne L, Schiaroli E, Ciervo A, Scaglione V, Paciaroni M, Mancini F, Paglia MG, Cardaci S, Pasticci MB, Francisci D, Baldelli F. Meningitis with cranial polyneuritis and cavernous sinus thrombosis by Borrelia crocidurae: First autochthonous case in Europe. Int J Infect Dis 2019; 82:30-32. [PMID: 30818047 DOI: 10.1016/j.ijid.2019.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
Borrelia crocidurae is endemic in West Africa, where it represents the leading cause of tick-borne relapsing fever (TBRF). TBRF typically presents with high fever and systemic symptoms, followed by recurrent episodes. Neurological complications may occur during febrile relapses. B. crocidurae is considered the most neurotropic agent of TBRF and is associated to severe neurological manifestations i.e. meningitis and encephalitis. To date, European cases of B. crocidurae infection have been reported in travelers returning from endemic areas. We report the first autochthonous case in Europe of B. crocidurae infection, presenting as meningitis with cranial polyneuritis and cavernous sinus thrombosis that were not preceded by classic febrile recurrences.
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Affiliation(s)
- Lisa Malincarne
- Infectious Diseases Clinic, Department of Medicine, Perugia University, Perugia, Italy.
| | - Elisabetta Schiaroli
- Infectious Diseases Clinic, Department of Medicine, Perugia University, Perugia, Italy
| | - Alessandra Ciervo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Vittoria Scaglione
- Infectious Diseases Clinic, Department of Medicine, Perugia University, Perugia, Italy
| | - Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, Perugia University, Perugia, Italy
| | - Fabiola Mancini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Maria Grazia Paglia
- Microbiology Laboratory and Infectious Diseases Biorepository, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Roma, Italy
| | - Salvatore Cardaci
- Infectious Diseases Clinic, Department of Medicine, Perugia University, Perugia, Italy
| | - Maria Bruna Pasticci
- Infectious Diseases Clinic, Department of Medicine, Perugia University, Perugia, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Department of Medicine, Perugia University, Perugia, Italy
| | - Franco Baldelli
- Infectious Diseases Clinic, Department of Medicine, Perugia University, Perugia, Italy
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Abstract
Isolated sphenoid sinusitis is a rare disorder and may present with severe complications due to its proximity to the orbital and intracranial areas. We report a 13-year-old boy hospitalized for septic shock with fever of unknown origin. Facial palsy was later noted. Brain magnetic resonance imaging showed a sphenoid mass and right cavernous sinus and internal jugular vein thrombosis. Biopsy revealed chronic rhinosinusitis. Complete recovery followed by an incision/drainage procedure and antibiotic treatment. Acute sphenoid sinusitis should be included in the differential diagnosis of septic manifestations mimicking central nervous system infection or cranial nerve palsy.
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Affiliation(s)
- Ming-Chun Chen
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Huai Ho
- Department of Infectious Disease, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Pau-Nyen Chong
- Department of Medical Imaging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jui-Hsia Chen
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Abstract
Background Orbital cellulitis is a relatively uncommon presentation in the emergency department, but orbital cellulitis complicated by intracranial extensions, loss of vision, and death has rarely been reported in the literature. Case presentation We report a 40-year-old Pakistani diabetic male complaining of 5 days of bilateral eye pain, proptosis, ophthalmoplegia, headache, and fever. A diagnosis of orbital cellulitis with intracranial extension was made. A computed tomography (CT) scan and a magnetic resonance imaging (MRI) were done on the patient and showed unremarkable orbits, extensive sinusitis, frontal abscess, and multiple septic emboli. The patient was admitted and on day 9 deteriorated and died. Conclusion Orbital cellulitis associated with intracranial extension is an extremely rare presentation, and the incidence is unknown. The use of contrast-enhanced imaging studies (CT/MRI) early on in the management of suspected orbital cellulitis is supported by the literature. Cerebritis and brain abscesses resulting from orbital cellulitis need advanced care from multidisciplinary teams. Further studies need to be done to provide recommendations on the use and benefit of surgical intervention.
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27
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van der Poel NA, Mourits MP, de Win MML, Coutinho JM, Dikkers FG. Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review. Eur Arch Otorhinolaryngol 2018; 275:2387-95. [PMID: 29998385 DOI: 10.1007/s00405-018-5062-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
Purpose Septic cavernous sinus thrombosis (CST) is a rare complication of infections in the head and neck area. CST is notorious for its bad prognosis, with high mortality and morbidity rates described in literature. However, these rates are based on old series. We question whether the prognosis of CST is currently still as devastating. The primary purpose of this study is to assess the mortality and morbidity of CST. Methods Using the databases of all relevant specialties in our tertiary referral hospital, we collected all the patients treated for CST in the period 2005–2017. In addition, a PubMed search, using the mesh term ‘cavernous sinus thrombosis’, was performed. Results We found 12 patients with CST in the study period. Of the 12 patients, 11 survived and 9 recovered without any permanent deficits. Seven patients were treated with anticoagulation, and in none of the patients we saw hemorrhagic complications. In literature, older articles describe higher mortality rates (14–80%), but more recent articles report mortality and morbidity rates similar to our results. Conclusions The prognosis of CST nowadays is more favorable than previously described. Anticoagulation seems to be a safe addition to antibiotic and surgical treatment, at least in patients without central nervous system infection.
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Wong SJ, Levi J. Management of pediatric orbital cellulitis: A systematic review. Int J Pediatr Otorhinolaryngol 2018; 110:123-9. [PMID: 29859573 DOI: 10.1016/j.ijporl.2018.05.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/29/2018] [Accepted: 05/03/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Orbital complications account for 74-85% of all complications from acute sinusitis, more often affect the pediatric population, and can result in devastating consequences. Therefore these patients require prompt diagnosis and proper management. We review and summarize the current literature to determine the appropriate management of each stage of pediatric orbital cellulitis and offer a new comprehensive literature-based algorithm. METHODS Data sources were PubMed/MEDLINE, and Google Scholar. Studies relevant to the management of each subcategory of the Chandler criteria in the pediatric population, limited to the period 1997 through Jan 2018, were compiled and interpreted. Seventy-one studies were reviewed in total. RESULTS Pre-septal and post-septal cellulitis can generally be managed non-surgically, while orbital abscess and cavernous sinus thrombosis are managed surgically. For subperiosteal abscess, non-surgical medical management has been successful in certain patients. Results of the literature review were summarized, and subsequently developed into a comprehensive algorithm for management, including criteria for age, location, and volume of abscess on imaging. CONCLUSIONS Orbital cellulitis, particularly subperiosteal abscesses, in children is not an absolute indication for immediate surgical intervention. Conservative measures can be safe and effective if appropriately used, depending on patient characteristics, clinical course, and imaging.
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29
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Safneck JR, Krawitz S. Blastomyces species and orbital apex syndrome: Unsuspected co-infection. Saudi J Ophthalmol 2018; 32:86-9. [PMID: 29755280 DOI: 10.1016/j.sjopt.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/01/2018] [Indexed: 11/21/2022] Open
Abstract
Blastomyces species are thermally dimorphic fungi existing as yeast in tissue. We report an initially immunocompetent patient with orbital apex syndrome (OAS) whose presentation suggested giant cell arteritis. Subsequently, metastatic carcinoma was entertained as a cause of OAS until bronchoscopy yielded Blastomyces species. The patient rapidly succumbed with multiorgan failure despite Amphotericin B administration. At post-mortem, Blastomyces co-infection with fungal hyphae in keeping with Aspergillus species was found in cavernous sinus and in infarcted optic nerve. To the best of our knowledge, co-infection with these two organisms in this clinical setting has not been reported.
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30
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Al-Mufti F, Amuluru K, El-Ghanem M, Changa AR, Singh IP, Gandhi CD, Prestigiacomo CJ. Spontaneous Bilateral Carotid-Cavernous Fistulas Secondary to Cavernous Sinus Thrombosis. Neurosurgery 2017; 80:646-654. [PMID: 28362925 DOI: 10.1093/neuros/nyw128] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 12/10/2016] [Indexed: 11/13/2022] Open
Abstract
Bilateral carotid cavernous fistulas are rare entities that can cause debilitating symptoms and can lead to more severe consequences if left untreated. Therefore, the recognition and adequate treatment of these pathologies is very important. We present 2 cases of bilateral carotid cavernous fistulas that arose as a result of cavernous sinus thrombosis. We review the literature and discuss the pathophysiology, symptomatology, management, and treatment of bilateral carotid cavernous fistulas. Within our own cases, treatment of the patients was varied. The patient in case 1 was successfully treated with endovascular therapy after a failed trial of anticoagulation. The patient in case 2 demonstrated resolution of bilateral carotid cavernous fistulas after anticoagulation therapy. Case 2 highlights the fact that certain cases of bilateral carotid cavernous fistulas due to cavernous sinus thrombosis may benefit from extensive anticoagulation therapy. If anticoagulation therapy is unsuccessful, endovascular therapy may prove beneficial in resolving the fistulous shunt.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Krishna Amuluru
- Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Mohammad El-Ghanem
- Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Abhinav R Changa
- Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Inder Paul Singh
- Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Chirag D Gandhi
- Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Charles J Prestigiacomo
- Department of Neurosurgery and Neu-roscience, Rutgers-New Jersey Medical School, Newark, New Jersey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moghaddasi M, Nabovvati M, Razmeh S. Bilateral Cavernous Sinus Thrombosis as First Manifestation of Primary Burkitt Lymphoma of the Thyroid Gland. Neurol Int 2017; 9:7133. [PMID: 28713532 PMCID: PMC5505089 DOI: 10.4081/ni.2017.7133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/19/2017] [Accepted: 05/27/2017] [Indexed: 11/23/2022] Open
Abstract
Cavernous sinus thrombosis (CST) is a rare condition that is usually associated with infections, pregnancy, vasculitis and some types of medication, such as the contraceptive pill and paraneoplastic. Primary Burkitt lymphoma (PBL) of the thyroid gland is very uncommon and the clinical description of such cases has been largely limited to case reports. In this paper, we present a case of CST as the first manifestation of PBL of the thyroid gland. To the best of our knowledge, our patient is the first case report of PBL of the thyroid gland that presents with bilateral CST.
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Affiliation(s)
| | | | - Saeed Razmeh
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
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Schear MJ, Weiss A, Rodgers R. Bilateral cavernous sinus thrombosis with septic lung lesions resulting from a nasal abscess. Am J Ophthalmol Case Rep 2017; 7:113-114. [PMID: 29260092 PMCID: PMC5722132 DOI: 10.1016/j.ajoc.2017.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/16/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matthew J Schear
- Northwell Health Department of Ophthalmology, Hofstra Northwell School of Medicine, 600 Northern Blvd, Suite 214, Great Neck, NY 11021, United States
| | - Alexander Weiss
- Northwell Health Department of Ophthalmology, Hofstra Northwell School of Medicine, 600 Northern Blvd, Suite 214, Great Neck, NY 11021, United States
| | - Rand Rodgers
- Northwell Health Department of Ophthalmology, Hofstra Northwell School of Medicine, 600 Northern Blvd, Suite 214, Great Neck, NY 11021, United States
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Abstract
Background This case illustrates the importance of prompt assessment and treatment of orbital cellulitis. In fact the ocular signs and symptoms may be associated with systemic complications which should be investigated and identified as soon as possible to avoid a poor prognosis. Case presentation A 46-year-old white woman presented to our emergency room with proptosis, ophthalmoplegia, and conjunctival chemosis of her left eye. An ophthalmologist, having diagnosed orbital cellulitis in her left eye, suspected a cavernous sinus thrombosis. Hematochemical and radiological examinations confirmed the cavernous sinus thrombosis and also showed septic pulmonary embolism. A blood culture indicated Streptococcus constellatus, which is a member of the Peptostreptococcus family, a saprophyte of the oral mucosa that can be pathogenic in immunocompromised persons. The odontogenic origin was then confirmed by dental radiography which showed a maxillary abscess. Her eye signs regressed after antibiotic and anticoagulant therapy. Conclusions This complex case shows the importance of a multidisciplinary approach for the management of orbital cellulitis, for the prompt diagnosis and treatment of eye injuries and possible complications, so as to avoid serious and permanent sequelae.
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Affiliation(s)
- D Allegrini
- Eye Unit, Humanitas Gavazzeni Hospital, Humanitas University, Bergamo, Italy.
| | - S Reposi
- Eye Clinic, Melegnano Hospital, Vizzolo Predabissi, Milan, Italy
| | - E Nocerino
- Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - A Pece
- Eye Clinic, Melegnano Hospital, Vizzolo Predabissi, Milan, Italy
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Wang YH, Chen PY, Ting PJ, Huang FL. A review of eight cases of cavernous sinus thrombosis secondary to sphenoid sinusitis, including a12-year-old girl at the present department. Infect Dis (Lond) 2017; 49:641-646. [PMID: 28535728 DOI: 10.1080/23744235.2017.1331465] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cavernous sinus thrombosis (CST) is a severe disease which can result from infection of any of the tissues drained by the cavernous sinus. We here review eight cases, including a 12-year-old girl, all secondary to sphenoid sinusitis. The clinical manifestations, laboratory data, imaging findings, pathogens, medications, surgical treatment and clinical outcomes were analyzed. All eight patients had headache and five of them fever. All cases were associated with one or more ophthalmic symptoms. In four cases, computed tomography/magnetic resonance imaging showed isolated sphenoid sinusitis. In three cases, streptococci were isolated from blood culture and two cases showed Staphylococcus aureus in blood and sinus cultures. In seven cases, surgery was undertaken. All eight subjects received antibiotics, and 5 were administered intravenous ceftriaxone and metronidazole. Six subjects received anticoagulation therapy and one received corticosteroids. No mortality was recorded. Three cases showed sequelae, including Lemierre syndrome, ophthalmic complaints, and cranial nerve paralysis. In conclusion, the management of CST should include intravenous antibiotic therapy, combined with endonasal sinus surgery.
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Affiliation(s)
- Yun-Hu Wang
- a Department of Pediatrics, Section of Infection , Taichung Veterans General Hospital , Taichung , Taiwan
| | - Po-Yen Chen
- a Department of Pediatrics, Section of Infection , Taichung Veterans General Hospital , Taichung , Taiwan.,b Department of Medicine , Chung Shan Medical University , Taichung , Taiwan
| | - Pei-Ju Ting
- a Department of Pediatrics, Section of Infection , Taichung Veterans General Hospital , Taichung , Taiwan
| | - Fang-Liang Huang
- a Department of Pediatrics, Section of Infection , Taichung Veterans General Hospital , Taichung , Taiwan.,c Department of Physical Therapy , Hung Kuang University , Taichung , Taiwan
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36
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Choi KY, Yang CJ. A case report of cavernous sinus thrombosis after trauma. Int J Pediatr Otorhinolaryngol 2017; 95:101-3. [PMID: 28576515 DOI: 10.1016/j.ijporl.2017.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 11/21/2022]
Abstract
Cavernous sinus thrombosis is a rare but well-documented complication of sinus disease, propagated by intracranial spread of infection via valveless veins of the midface, with facial cellulitis as an uncommon source of infection. We present a case of significant intracranial thromboses secondary to nasal dorsal abscess after trauma that was successfully treated with bedside drainage of the abscess in addition to broad-spectrum antibiotics, anticoagulation, and steroids, and remains asymptomatic with seven months follow-up.
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Stabler SP, Freehauf C, Allen RH, Thomas J, Gallagher R. Potential Misdiagnosis of Hyperhomocysteinemia due to Cystathionine Beta-Synthase Deficiency During Pregnancy. JIMD Rep 2017; 37:55-61. [PMID: 28275971 DOI: 10.1007/8904_2017_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 12/23/2022] Open
Abstract
Extreme hyperhomocysteinemia with low cystathionine and cysteine is virtually diagnostic of cystathionine beta-synthase (CBS) deficiency since remethylation defects and hypermethioninemia due to other inborn errors cause elevated serum cystathionine. However, a pregnant CBS deficient patient was found to have elevated cystathionine in addition to elevated total homocysteine and methionine at 23 weeks of gestation and post-delivery cystathionine decreased to the lower level of normal. A second patient with cystathionine values during gestation also showed a rise from the low pre-pregnant value to massive elevation by delivery. Her infant had severe hyperhomocysteinemia in cord blood with a massive elevation of cystathionine, S-adenosylmethionine, and S-adenosylhomocysteine. The infant corrected her homocysteine value by 2 months and is not affected. This data demonstrates that the fetus when exposed to high homocysteine and methionine has increased synthesis of cystathionine which cannot be cleared because the fetus lacks cystathionine gamma-lyase, and thus cystathionine is returned to the mother's circulation. This situation could lead to a misdiagnosis of the cause of hyperhomocysteinemia in a previously undiagnosed pregnant CBS deficient patient. Assays combining homocysteine with cystathionine measurements are commonly available from commercial laboratories in the USA. The recognition of CBS deficiency vs. remethylation disorders is important in order to maximize treatment. The cord blood values revealed a major disturbance in methionine metabolism including a potential for impaired transmethylation reactions in the fetus due to the buildup of S-adenosylhomocysteine. It is possible that monitoring maternal cystathionine during gestation could provide another measure of fetal exposure to homocysteine.
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Affiliation(s)
- Sally P Stabler
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, 12700 E. 19th Avenue, Room 9122, Bldg. RC2, Campus Box B170, Aurora, CO, USA.
| | - Cynthia Freehauf
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert H Allen
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, 12700 E. 19th Avenue, Room 9122, Bldg. RC2, Campus Box B170, Aurora, CO, USA
| | - Janet Thomas
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Renata Gallagher
- Department of Pediatrics, University of California at San Francisco, 330 Post Street, 6th Floor, San Francisco, CA, USA
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Sadineni RT, Velicheti S, Kondragunta CS, Bellap NC. Multiple Cerebrovascular Complications due to Sphenoid Sinusitis. J Clin Diagn Res 2016; 10:TD03-TD05. [PMID: 28050478 DOI: 10.7860/jcdr/2016/23899.8905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/28/2016] [Indexed: 11/24/2022]
Abstract
Sphenoiditis is of particular interest because the sphenoid sinus has thin wall and its special anatomical location facilitate dissemination of infection to many intracranial structures including vascular structures. The main objective of this report is to gain insight into patterns of presentation and imaging findings in cerebrovascular complications of sphenoid sinusitis and to emphasize the need of reviewing Brain Computed Tomography Scan in all windows. This is a report of 32-year-old young female presented with fever and headache who was diagnosed to have sphenoid sinusitis after radiological examination. Sphenoid sinusitis may involve several intracranial structures, with potentially severe or even fatal complications. Prompt diagnosis and antibiotic/antifungal therapy is essential to minimize mortality and morbidity.
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Affiliation(s)
- Raghu Teja Sadineni
- Seniour Resident, Department of Radiology, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation , Vijayawada, Andhra Pradesh, India
| | - Sandeep Velicheti
- Assistant Professor, Department of Radiology, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation , Vijayawada, Andhra Pradesh, India
| | - Chandra Sekhar Kondragunta
- Professor, Department of Radiology, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation , Vijayawada, Andhra Pradesh, India
| | - Narayan Chander Bellap
- Professor & HOD, Department of Radiology, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation , Vijayawada, Andhra Pradesh, India
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Weerasinghe D, Lueck CJ. Septic Cavernous Sinus Thrombosis: Case Report and Review of the Literature. Neuroophthalmology 2016; 40:263-276. [PMID: 27928417 DOI: 10.1080/01658107.2016.1230138] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 10/20/2022] Open
Abstract
Septic cavernous sinus thrombosis is a rare but serious complication of infection of the cavernous sinuses. There are no randomised, controlled trials of management of this condition and existing reviews of the literature are somewhat dated. The authors report a case with a favourable outcome and then present the findings of a literature review of the management of this condition. Outcome data suggest that corticosteroids are of equivocal benefit whereas antibiotics and anticoagulation are beneficial.
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Affiliation(s)
- Dinushi Weerasinghe
- Department of Neurology, The Canberra Hospital and Australian National University Medical School , Canberra, Australia
| | - Christian J Lueck
- Department of Neurology, The Canberra Hospital and Australian National University Medical School , Canberra, Australia
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40
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Abstract
Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these “space infections” has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms “odontogenic infections,” “complications,” and “risk factors.”
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Affiliation(s)
- Rishi Kumar Bali
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Parveen Sharma
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Shivani Gaba
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Avneet Kaur
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Priya Ghanghas
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
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41
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López F, Santamarta E, Martínez P, Sáiz-Ayala A, Llorente JL. Cavernous sinus thrombosis during pregnancy. Auris Nasus Larynx 2016; 44:232-236. [PMID: 27146007 DOI: 10.1016/j.anl.2016.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/24/2016] [Accepted: 04/01/2016] [Indexed: 11/27/2022]
Abstract
Cavernous sinus thrombosis (CST) represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. We present the case of a 24-year-old pregnant woman with intraorbital abscess and CST secondary to Streptococcus milleri. Surgical intervention included orbital abscess drainage and dental extraction, medical therapy included intravenous antibiotic, heparin, and methylprednisolone and an elective cesarean section was performed. The latter was the key point to resolution the disease.
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Affiliation(s)
- Fernando López
- Department of Otorhinolaryngology and Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - Elena Santamarta
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Patricia Martínez
- Department of Otorhinolaryngology and Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Antonio Sáiz-Ayala
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José L Llorente
- Department of Otorhinolaryngology and Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Abstract
Septic cerebral venous sinus thrombosis, once a common and deadly disease, has fortunately become rare now. Not only that the incidence has fallen significantly after the antibiotic era, the morbidity and mortality has also decreased substantially. Cavernous sinus thrombosis is by far the commonest form of septic cerebral venous sinus thrombosis. Due to its rare occurrence, a lot of current generation clinicians have not encountered the entity in person. Despite all the advances in diagnostic modalities, a high index of clinical suspicion remains the mainstay in prompt diagnosis and management of this potentially lethal condition. Keeping this in view, the authors have reviewed the subject including the old literature and have summarized the current approach to diagnosis and management. Septic cavernous thrombosis is a fulminant disease with dramatic presentation in most cases comprised of fever, periorbital pain and swelling, associated with systemic symptoms and signs. The preceding infection is usually in the central face or paranasal sinuses. The disease rapidly spreads to contralateral side and if remains undiagnosed and untreated can result in severe complications or even death. Prompt diagnosis using radiological imaging in suspected patient, early use of broad spectrum antibiotics, and judicial use of anticoagulation may save the life and prevent disability. Surgery is used only to treat the nidus of infection.
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43
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Arunkumar KV. Orbital Infection Threatening Blindness Due to Carious Primary Molars: An Interesting Case Report. J Maxillofac Oral Surg 2015; 15:72-5. [PMID: 26929556 DOI: 10.1007/s12663-015-0801-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Distant spread of infection due to dental abscess in head and neck region is often reported in the literature. Orbital cellulitis or abscess although rare as a complication from decayed primary teeth in children is not an exception. The periapical infection from the maxillary primary molar spreads easily to the maxillary sinus first and followed by entry into the orbit through the orbital floor or through the ethmoidal sinuses. This if untreated may lead to orbital abscess, proptosis, progressive loss of vision, intracranial extension and even death. MATERIALS AND METHODS A 10 year old boy presenting with severe pain, proptosis of right eyeball, ophthalmoplegia and blindness. CONCLUSION Managed successfully with timely medical and surgical intervention with complete restoration of vision. This case presented emphasizes the primary teeth care necessary in children which if unchecked can cause fatal complications.
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Affiliation(s)
- K V Arunkumar
- Department of Oral and Maxillofacial Surgery, NH-58, Delhi-Meerut-Haridwar Bypass, Subhartipuram, Meerut, 250005 UP India
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44
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Cho JY, Kim HM, Ryu JY. Cavernous sinus thrombosis progression from trismus. J Korean Assoc Oral Maxillofac Surg 2015; 41:43-7. [PMID: 25741468 PMCID: PMC4347033 DOI: 10.5125/jkaoms.2015.41.1.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/23/2014] [Accepted: 09/28/2014] [Indexed: 11/18/2022] Open
Abstract
In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.
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Affiliation(s)
- Jin Yong Cho
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyeon Min Kim
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Young Ryu
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
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45
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Varshney S, Malhotra M, Gupta P, Gairola P, Kaur N. Cavernous sinus thrombosis of nasal origin in children. Indian J Otolaryngol Head Neck Surg 2014; 67:100-5. [PMID: 25621244 DOI: 10.1007/s12070-014-0805-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022] Open
Abstract
Cavernous sinus thrombosis is a rare presentation. Early diagnosis and aggressive treatment are required to prevent morbidity and mortality. Nasal infections can give rise to serious intracranial complications. Presented here is a case series of cavernous sinus thrombosis of nasal septic origin. The purpose of this article is to report our experience in pediatric patients with this illness to ascertain a clinical course and outcomes for further clinical application. Eight (08) cases of nasalseptic origin of cavernous sinus thrombosis ata tertiary care teaching hospital in the north India region of India were included in the study. Cases presented with various symptoms like headache, proptosis, ophthalmoplegia and fever. The patients were investigated by doing High Resolution Computed Tomography of nose & PNS and brain with intravenous contrast. The cases were treated with intravenous broad spectrum antibiotics. Eight patients less than 16 years of age (mean age of 11.2 years)diagnosed with cavernous sinus thrombophlebitis due to nasal septic focus over the period of 05 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children. A conservative management strategy with antibiotics gave a good prognosis in these cases. There were no deaths. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.
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Affiliation(s)
- Saurabh Varshney
- Department of E.N.T. & Head Neck Surgery/Microbiology, All India Institute of Medical Sciences, Rishikesh, 249201 Uttarakhand India
| | - Manu Malhotra
- Department of E.N.T. & Head Neck Surgery/Microbiology, All India Institute of Medical Sciences, Rishikesh, 249201 Uttarakhand India
| | - Pratima Gupta
- Department of E.N.T. & Head Neck Surgery/Microbiology, All India Institute of Medical Sciences, Rishikesh, 249201 Uttarakhand India
| | - Priyanka Gairola
- Department of E.N.T. & Head Neck Surgery/Microbiology, All India Institute of Medical Sciences, Rishikesh, 249201 Uttarakhand India
| | - Navjot Kaur
- Department of E.N.T. & Head Neck Surgery/Microbiology, All India Institute of Medical Sciences, Rishikesh, 249201 Uttarakhand India
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Chung HC, Park SH, Kim ES, Kim YI, Lee SH, Nam-Goong IS. A case of cavernous sinus thrombophlebitis and meningitis as a complication in osteopetrosis. J Bone Metab 2014; 21:227-32. [PMID: 25247162 PMCID: PMC4170087 DOI: 10.11005/jbm.2014.21.3.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
Osteopetrosis is a rare genetic bone disease characterized by increased bone density but prone to breakage due to defective osteoclastic function. Among two primary types of autosomal dominant osteopetrosis (ADO), osteopetrosis type II is characterized by sclerosis of bones, predominantly involving the spine, the pelvis, and the skull base. Fragility of bones and dental abscess are leading complications. This report presents a case of osteopetrosis in a 52-years-old female, which was complicated by the development of cavernous sinus thrombophlebitis and meningitis. She was suffered from multiple fractures since one year ago. Laboratory data revealed elevated serum levels of tartrate resistant acid phosphatase (TRAP) without carbonic anhydrase II DNA mutation. A thoracolumbar spine X-ray showed, typical findings of ADO type II (ADO II; Albers-Schönberg disease), prominent vertebral endplates so called the 'rugger jersey spine'. Her older sister also showed same typical spine appearance. We report a case of ADO II with cavernous sinus thrombophlebitis and meningitis that was successfully treated with long-term antibiotics with right sphenoidotomy.
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Affiliation(s)
- Hyun Chul Chung
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - So Hyun Park
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Sook Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Il Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sun Ho Lee
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Il Seong Nam-Goong
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Yeo GS, Kim HY, Kim H, Kwak EJ, Jung YS, Park HS, Jung HD. Cavernous sinus thrombosis caused by a dental infection: a case report. J Korean Assoc Oral Maxillofac Surg 2014; 40:195-8. [PMID: 25247150 PMCID: PMC4170663 DOI: 10.5125/jkaoms.2014.40.4.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 11/15/2022] Open
Abstract
Cavernous sinus thrombosis not only presents with constitutional symptoms including fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. It is known to occur secondary to the spread of paranasal sinus infections in the nose, ethmoidal and sphenoidal sinuses. However, paranasal sinus infection of dental origin is rare. The following is a case of cavernous sinus thrombosis due to the spread of an abscess in the buccal and pterygomandibular spaces via buccal mucosal laceration.
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Affiliation(s)
- Gi-Sung Yeo
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyun Young Kim
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | | | - Eun-Jung Kwak
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Sik Park
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hwi-Dong Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
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Abstract
Septic cavernous sinus thrombosis (CST) related to dental infection is a rare clinical event. The septic CST is a disease of high morbidity and mortality. The prompt diagnosis and timely treatment of septic CST is cornerstone of successful outcome. The dental infection should be given due attention, as to prevent CST. In this case report of immunocompetent female, we highlighted the role of dental abscess in producing bilateral CST and facial palsy. The close collaboration between dentist and neurologist and early institution of antibiotics led to complete recovery at follow-up after 3 months. The dental infection should never be neglected as it is the interface of serious intracranial complication like CST.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Junewar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Hari Ram
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Uma Shanker Pal
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
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Singh SK, James E, Sabarigirish K, Swami H, Sood T. Bilateral orbital complications of paediatric rhinosinusitis. Med J Armed Forces India 2014; 70:68-72. [PMID: 24623951 DOI: 10.1016/j.mjafi.2012.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 11/12/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The spread of infection from the ethmoid sinuses to the orbit occurs directly through a congenital dehiscence of the lamina papyracea or via haematogenous spread through ophthalmic venous system. Hence orbital complications of paediatric rhinosinusitis are usually unilateral at presentation. METHODS We describe three children with bilateral orbital cellulitis that occurred as a complication of rhinosinusitis without intracranial spread of the infection. The children ranged in the age group from 4 to 7 years. All these children had a prolonged hospital stay from 14 to 25 days and underwent multiple surgical procedures to drain the subperiosteal abscess. These children presented to the hospital with bilateral orbital cellulitis without significant past history. All of them on radiological evaluation showed subperiosteal abscess involving only one orbit. They were taken up for functional endoscopic sinus surgery and the subperiosteal abscess was drained endoscopically with partial removal of lamina papyracea. One case required second surgery despite good recovery for two days post first surgery. RESULT AND CONCLUSION Two cases had severe unilateral visual loss at presentation but both recovered dramatically after the surgery. All cases had uneventful recovery with no residual disability. The purpose of this article is to discuss the reasons for bilateral orbital complications of rhinosinusitis at initial presentation despite the previous hypothesis of unilateral involvement.
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Affiliation(s)
- S K Singh
- Associate Professor, Dept of ENT, AFMC, Pune-40, India
| | - E James
- Ex Professor & HOD, Dept of ENT, AFMC, Pune 40, India
| | | | - H Swami
- Associate Professor, Dept of ENT, AFMC, Pune-40, India
| | - Tarun Sood
- Resident, Dept of ENT, AFMC, Pune 40, India
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Golan E, Wong K, Alahmadi H, Agid RF, Morris A, Sharkawy A, Zadeh G. Endoscopic sphenoid sinus drainage in Lemierre syndrome. J Clin Neurosci 2013; 21:346-8. [PMID: 24060623 DOI: 10.1016/j.jocn.2013.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/01/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
Abstract
Lemierre syndrome is a rare condition arising from an invasive oropharyngeal infection, which leads to septic thrombophlebitis of the internal jugular vein and multi-organ septic embolization. Intracranial complications are rare but serious, including subdural empyema, cavernous sinus thrombosis, and internal carotid artery aneurysms. We report a patient with Lemierre syndrome with multiple intracranial complications despite aggressive antimicrobial therapy. The patient eventually required transsphenoidal endoscopic drainage of the sphenoid sinus to help eradicate the infectious source. We postulate that in patients with Lemierre syndrome with evidence of infection in the paranasal sinuses, endoscopic sinus drainage can be an adjunct to antimicrobial therapy in achieving infection control.
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Affiliation(s)
- E Golan
- Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, 399 Bathurst Street, 2 McLaughlin 411P, Toronto, ON Canada M5T 2S8; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - K Wong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - H Alahmadi
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - R F Agid
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - A Morris
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Sharkawy
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - G Zadeh
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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