Challenging presentations of cavernous sinus thrombophlebitis

详细信息    查看全文

• 作者：Courtney L. Kraus (1)
  Susan M. Culican (1)
  
• 关键词：Cavernous sinus thrombosis ; Septic thrombophlebitis ; Cranial nerve palsies ; Imaging
• 刊名：Journal of Ophthalmic Inflammation and Infection
• 出版年：2012
• 出版时间：September 2012
• 年：2012
• 卷：2
• 期：3
• 页码：133-136
• 全文大小：239KB
• 参考文献：1. Ho CF, Huang YC, Wang CJ, Chiu CH, Lin TY (2007) Clinical analysis of computed tomography-staged orbital cellulitis in children. J Microbiol Immuno Infect 40(6):518鈥?24
  2. Cannon ML, Antonio BL, McCloskey JJ, Hines MH, Tobin JR, Shetty AK (2004) Cavernous sinus thrombosis complicating sinusitis. Pediatr Crit Care Med 5(1):86鈥?8 CrossRef
  3. Ebright JR, Pace MT, Niazi AF (2001) Septic thrombosis of the cavernous sinuses. Arch Intern Med 161:2671鈥?676 CrossRef
  4. Southwick FS, Richardson EP Jr, Swartz MD (1986) Septic thrombosis of the dural venous sinuses. Medicine 65:82鈥?06 CrossRef
  5. Hegde V, Mitry D, McAteer D, Azuara-Blanco A (2009) Orbital cellulitis and cavernous sinus thrombosis secondary to necrobacillosis. Eye 23:1472鈥?473 CrossRef
  6. Kaplan SL et al (2004) Decrease of invasive pneumococcal infections in children among 8 children's hospitals in the United States after the introduction of the 7-valent pneumococcal conjugate vaccine. Pediatrics 113(3):443鈥?49 CrossRef
  7. Ito E, Saito K, Nagatani T, Teranishi M, Aimi Y, Wakabayashi T (2009) Cavernous sinus thrombophlebitis caused by porphyromonas gingivalis with abscess formation extending to the orbital cavity. Neurol Med Chir (Tokyo) 49(8):370鈥?73 CrossRef
  8. Sanchez TG, Cahali MB, Murakami MS, Butugan O, Miniti A (1997) Septic thrombosis of orbital vessels due to nasal infections. Am J Rhinol 11(6):429鈥?33 CrossRef
  9. Hoshino C, Satoh N, Sugawara S, Kuriyama C, Kikuchi A, Ohta M (2007) Septic cavernous sinus thrombosis complicated by narrowing of the internal carotid artery, subarachnoid abscess and multiple pulmonary septic emboli. Intern Med 46(6):317鈥?23 CrossRef
  10. Ahn Yuen SJ, Rubin PAD (2003) Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome. Arch Ophthalmol 121:491鈥?99 CrossRef
  11. Yen MT, Yen KG (2005) Effect of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess. Ophthal Plast Reconstr Surg 21:363鈥?66 CrossRef
  12. Hennemann S, Crawford P (2007) What is the best initial treatment for orbital cellulitis in children? J Fam Pract 56(8):662鈥?64
  13. Levine SR, Twyman RE, Gilman S (1988) The role of anticoagulation in cavernous sinus thrombosis. Neurology 38:517鈥?22 CrossRef
  14. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, deVeber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER (2008) Management of stroke in infants and children: a scientific statement from a special writing group of the American Heart Association stroke council and the council on cardiovascular disease in the young. Stroke 39:2644鈥?691 CrossRef
  
• 作者单位：Courtney L. Kraus (1)
  Susan M. Culican (1)
  
  1. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
  

文摘

Aim The purpose of this study was to describe two challenging cases of septic cavernous sinus thrombosis (CST), which presented with vastly different clinical signs and symptoms. Methods We present two cases of CST with markedly differing clinical presentations, medical comorbidities, and degree of impairment. Initial imaging of each patient failed to show thromboembolic disease. Results Both patients required multiple imaging procedures to arrive at the correct diagnosis. Each child did respond to treatment once the correct diagnosis was made. Conclusion CST can have a highly variable clinical presentation, from a subtle sixth nerve palsy to complete ophthalmoplegia and loss of periorbital sensation and corneal reflex. Onset of symptoms may be acute and fulminant or indolent and delayed. The diagnosis is challenging, requiring clinical suspicion and confirmation by imaging. These cases illustrate the importance of retaining clinical suspicion when cranial nerve palsies persist and how valuable rescanning a patient can be.