Timely and conservative anticoagulation in Septic Cavernous Sinus Thrombosis: A case report

ABSTRACT

Background@#Cavernous Sinus Thrombosis (CST) is a rare and life-threatening condition with antibiotics as the mainstay of therapy for those due to infection. While controversy exists, recent retrospective reviews using anticoagulation reveal potential mortality reduction with a low risk of adverse events such as intracranial hemorrhage (ICH). The optimal timing and duration of treatment are unknown.@*The Case@#We report a 32-year-old female who presented with fever, headache, complete bilateral ophthalmoplegia, cellulitis, and a cranial MRV diagnostic of CST. She received antibiotics targeted to MRSA organisms isolated from eye and blood specimen. Further, into the course, the patient had an onset of aphasia and right-sided hemiplegia. Workup revealed multiple cranial infarcts with narrowing of the left internal carotid artery, likely representing thrombus as the source of embolism. The decision to anticoagulate was reevaluated and subsequently started. The patient was reassessed clinically after two months to have improved motor strength and speech return; thus, anticoagulation was discontinued.@*Discussion@#Although data are lacking, most recent reports favor the use of anticoagulation. Some authors recommend initiation in patients with deteriorating neurologic status despite antibiotics and hydration. The higher frequency of ICH in anticoagulated CST patients with CNS infection is a basis for some authors to withhold treatment. The treatment duration varies with different studies, generally ranging from several weeks to three months or more.@*Conclusion@#Further studies are needed to define the exact role of anticoagulation, particularly its timing and duration. Nevertheless, timely identification of the condition and constant re-evaluation are critical to early patient recovery.