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CASE REPORT
Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis
  1. Christodoulos Dolapsakis1,
  2. Eleftheria Kranidioti1,
  3. Sofia Katsila1 and
  4. Michael Samarkos2,3
  1. 1 3rd Department of Medicine, Evaggelismos General Hospital, Athens, Greece
  2. 2 1st Department of Medicine, Laikon Hospital, Athens, Greece
  3. 3 National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
  1. Correspondence to Professor Michael Samarkos, msamarkos{at}gmail.com

Abstract

We report a case of septic thrombosis of the right cavernous sinus in a diabetic woman in her late 70’s due to ipsilateral sphenoid sinusitis. The diagnosis was delayed and made only after the abrupt and dramatic appearance of the manifestations of sinus thrombosis. The patient developed, among the other symptoms, right peripheral facial palsy, which is a very rare manifestation in cavernous sinus thrombosis (CST). She was treated with broad-spectrum antibiotics and enoxaparin. The day of the scheduled drainage of sphenoid sinus—24 hours after the initiation of anticoagulation—she developed fatal subarachnoid haemorrhage. Our case demonstrates the difficulty of timely diagnosis of acute sphenoid sinusitis which has emerged as the most common primary infectious source potentially leading in CST. It also underscores the uncertainty concerning the use of anticoagulation in cerebral sinus thrombosis of infectious origin.

  • ear, nose and throat/otolaryngology
  • cranial nerves
  • infection (neurology)
  • neuroimaging

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Footnotes

  • Contributors CD: cowrote the first draft of the manuscript. EK: cowrote the first draft of the manuscript. SK: reviewed the literature. MS: reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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