Elsevier

Pediatric Neurology

Volume 24, Issue 2, February 2001, Pages 123-127
Pediatric Neurology

Original article
Cavernous sinus thrombophlebitis in children

https://doi.org/10.1016/S0887-8994(00)00255-1Get rights and content

Abstract

Eight Thai patients less than 15 years of age who were diagnosed with cavernous sinus thrombophlebitis at Ramathibodi Hospital, Bangkok, Thailand over the past 30 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children and adults. Despite severe neurologic dysfunction during admission, including blindness, there was neither death nor severe permanent deficit found in the majority of the patients. Only one patient experienced mild hemiparesis caused by cerebral infarction, which was secondary to this condition. 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.

Introduction

Cavernous sinus thromboplebitis, which was first reported by Duncan in 1821 [1], is an uncommon condition in pediatric patients. Infection is the common cause of this fatal disease. Mortality and morbidity rates associated with this disease were high, especially before the antibiotic era. There have been reports describing the epidemiology, clinical course, and outcomes in pediatric and adult patients [2], [3], [4], [5], [6], [7]. A series reported by Shaw in 1952 [2] included 60 patients who demonstrated high mortality and morbidity rates in this condition. Another study in Indian adult and pediatric patients confirmed the same clinical course and outcomes [6].

The purpose of this article is to report our experience in pediatric patients with this devastating neurologic illness to ascertain a clinical course and outcomes for further clinical application.

The medical records of pediatric patients less than 15 years of age with the diagnosis of cavernous sinus thrombophlebitis who were admitted to the Department of Pediatrics, Ramathibodi Hospital from 1969-1999 were reviewed. Cavernous sinus thrombophlebitis was diagnosed according to previously described clinical manifestations, which included dysfunction of the structures surrounding the cavernous sinus (CN II, III, IV, VI, V1, and/or V2) and the cavernous portion of the internal carotid artery. Predisposing cause, initial clinical presentation, investigation, isolated microorganism, treatment, hospital course, and the outcome were collected.

Section snippets

Results

There were eight patients, six males and two females ranging from 2 to 14 years of age, in this study. Table 1 lists the predisposing cause, initial clinical manifestation, site of initial infection, blood culture, cerebrospinal fluid (CSF) culture, and outcome obtained in each patient. The clinical courses of two patients were interesting and are presented in detail as follows.

Discussion

Cavernous sinus thromboplebitis is a serious neurologic complication of infection [7]. Although it is not a common illness, it can cause severe neurologic deficits and death. In the past the mortality and morbidity rates were high; in 1961, Yarington [3] demonstrated a mortality rate of 72.8% and a morbidity rate of 65.3%. Patients who suffer from this condition may experience double vision caused by oculomotor weakness, blindness, motor dysfunction, or hypopituitarism [5], [8]

This condition

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