RESUMO
Cavernous sinus thrombophlebitis is characterized by edema of the eyelids and the conjunctivae, and paralysis of the cranial nerves. It is rare, often misdiagnosed or underestimated by neurosurgeons, and is generally related with high rates of mortality and morbidity. High rate of suspicion is required for early diagnosis, and aggressive managements can lead to better outcomes. With recent advancements in antibiotic therapies, the mortality rate has been decreased to less than 30%. However, the morbidity remains high and complete recovery is rare. A 69-year-old woman presented with headache and right ocular pain with sixth cranial nerve palsy for one week. Under the suspicion of Tolosa-Hunt syndrome, steroid treatment was done. On discharge, there was improvement in right ocular pain, but the cranial nerve palsy remained. Subsequently, the patient returned with left ocular pain, lid swelling, redness, ecchymosis of conjunctiva, and ptosis. Enhanced brain magnetic resonance imaging revealed an asymmetrically enlarged left cavernous sinus with heterogeneously enhancing contour. Intravenous antibiotics and oral steroids along with anticoagulant medications were administered.
Assuntos
Idoso , Feminino , Humanos , Doenças do Nervo Abducente , Antibacterianos , Encéfalo , Seio Cavernoso , Trombose do Corpo Cavernoso , Cavernas , Túnica Conjuntiva , Doenças dos Nervos Cranianos , Nervos Cranianos , Diagnóstico Precoce , Equimose , Edema , Exoftalmia , Pálpebras , Cefaleia , Imageamento por Ressonância Magnética , Paralisia , Esteroides , Síndrome de Tolosa-HuntRESUMO
Septic inflammation and thrombosis of the cavernous sinus was extremely fatal in the preantibiotic era. After the introduction of antibiotics, the incidence of septic cavernous thrombophlebitis has diminished significantly. It is, however, still a serious disease accompanied by a high morbidity and mortality rate. Therefore, a high index of suspicion and aggressive initiation of treatment is of the utmost importance for the prognosis. A case of cavernous sinus thrombophlebitis and abducence nerve palsy which takes place secondary to petrositis was diagnosed by magnetic resonance imaging (MRI), and is presented here. The resolution of septic thrombus and complete recovery of sixth (abducens) nerve palsy was observed with treatment with antibiotics and steroids accompanied by tympanotomy tube placement.
Assuntos
Antibacterianos , Trombose do Corpo Cavernoso , Seio Cavernoso , Incidência , Inflamação , Imageamento por Ressonância Magnética , Mortalidade , Paralisia , Petrosite , Prognóstico , Esteroides , Tromboflebite , TromboseRESUMO
Lateral sinus thrombophlebitis is a very rare complication of paranasal sinusitis. This disease can result in a fatal outcome if not treated with proper antibiotics or surgical intervention. Recently, the authors came across a case of lateral sinus thrombophlebitis resulting from cavernous sinus thrombophlebitis complicated by isolated sphenoid sinusitis. Because of a severe and persistent headache, the case was initially admitted and managed as though the patient was suffering from Tolosa-Hunt syndrome. Hemifacial hypoesthesia, periorbital swelling and meiosis on the right side developed during tentative treatment. High resolution computed tomography showed isolated sphenoid sinusitis with partial bony dehiscence on the roof of left sphenoid sinus. Magnetic resonance images showed multiple thrombosis in the cavernous sinus, internal carotid artery, sigmoid sinus and lateral sinus on the right side. Antibiotics, thrombolytics and endoscopic surgical intervention of sinusitis prevented a fatal outcome in spite of remaining hemifacial hypoesthesia and ptosis on the right side.