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Case report
Diagnostic difficulties in a patient with multiple sclerosis who presents with cranial nerve palsies: an unusual complication of dental work
  1. Jennifer Cathcart1,2,
  2. Rebecca Caitlin Johnson1,2,
  3. Nicholas Hughes1,2 and
  4. Manish Patel1,2
  1. 1NHS Lanarkshire, Bothwell, UK
  2. 2General Medicine, University Hospital Wishaw, Wishaw, UK
  1. Correspondence to Dr Jennifer Cathcart; jeni123{at}


A woman in her 60s with multiple sclerosis (MS) presented with right-sided ptosis, right sixth nerve palsy, right facial paraesthesia and signs of sepsis. She had a recent diagnosis of a dental abscess. Investigations revealed a right submasseter abscess leading to bacterial meningitis (Streptococcus intermedius) and a cavernous sinus thrombosis. She was managed in intensive care and underwent surgical drainage of the abscess. Anticoagulation for 6 months was planned. Cavernous sinus thrombosis is a very rare complication of a dental abscess, and even less frequently associated with submasseter abscesses. The case was complicated by a history of MS, to which the patient’s symptoms and signs were initially attributed to. This case highlights the diagnostic pitfalls, and aims to enhance learning around similar cases. To the best of our knowledge, this is the first case report of a masseter/submasseter abscess leading to cavernous sinus thrombosis.

  • oral and maxillofacial surgery
  • multiple sclerosis
  • cranial nerves

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  • Contributors JC: discussion, presentation, treatment, outcome and follow-up and consenting patient. RCJ: investigations section and differential section. NH: summary and title. MP: finial edit, and review and planning of case report. All authors: reading and editing.

  • 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 for publication Obtained.

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