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1.
Eur J Med Res ; 26(1): 120, 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34615537

RESUMO

BACKGROUND: Cases of acute sphenoid sinusitis complicated by septic cavernous sinus (CS) thrombosis and internal carotid artery (ICA) stenosis are rarely reported. Different causative pathogens have been reported for this condition. We present two extremely rare and special cases with diverse clinical presentations and outcomes. Case 1 involved a female patient with less extensive sinusitis, but critical ICA occlusion. Case 2 involved a male patient with extensive pansinusitis, meningitis, cerebritis, and vasculitis due to fungal infection, but less stenosis of the ICA lumen. Both patients underwent surgical debridement and received broad-spectrum antibiotics. Additional anti-fungal medication was also administered in Case 2. However, outcomes differed considerably between cases. DISCUSSION: Case 1 recovered with minimal neurological deficits and had Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) scores of 5 and 2, respectively; however, the Case 2 had GOS and mRS scores of 3 and 4, respectively. Although rare, septic CS thrombosis with ICA stenosis can lead to unexpected and severe neurological sequelae. Fungal infection can result in catastrophic complications and poorer prognosis. CONCLUSION: In addition to early detection, aggressive surgical debridement and adequate antimicrobial treatment are crucial to satisfactory outcomes in patients with septic CS thrombosis complicated with ICA stenosis.


Assuntos
Artéria Carótida Interna/patologia , Estenose das Carótidas/fisiopatologia , Trombose do Corpo Cavernoso/complicações , Doenças do Sistema Nervoso/patologia , Sepse/complicações , Adulto , Antibacterianos/uso terapêutico , Trombose do Corpo Cavernoso/tratamento farmacológico , Trombose do Corpo Cavernoso/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Prognóstico , Sepse/tratamento farmacológico , Sepse/microbiologia , Adulto Jovem
2.
Clin Neurol Neurosurg ; 197: 106092, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32693341

RESUMO

BACKGROUND AND PURPOSE: Septic cavernous sinus thrombosis (CST) is a rare, life-threatening disease with infectious thrombosis causing associated complications resulting in high morbidity and mortality. We report a series of CST patients with assessment of arterial and intracranial complications. METHODS: We used the radiology database from a large, academic tertiary care center to collect all patients treated with CST between 2002 and 2019. Patient demographics, source of infection, treatment course and outcomes were evaluated. A review of the recent literature was also performed for similar reported complications from CST. RESULTS: 14 patients with CST treated during this time period were assessed. Of the 14 patients, 1 patient died. 7 patients had unilateral narrowing of ICA while 3 patients had bilateral narrowing. The ICA narrowing was reversible in 10/12 patients and improvement but persistent narrowing in one patient. One patient had an infectious pseudo aneurysm that was treated by coiling. Extension of thrombosis to the transverse- sigmoid sinuses and internal jugular vein were seen in 3 patients. Three patients had subdural empyema which was treated surgically. CONCLUSION: The prognosis of CST has improved with advancement in treatment, but complications are not infrequent.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico por imagem , Sepse/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Trombose do Corpo Cavernoso/complicações , Trombose do Corpo Cavernoso/microbiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/complicações , Sepse/microbiologia , Infecções Estafilocócicas/microbiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
J Clin Neurosci ; 68: 111-116, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31331748

RESUMO

In this magnetic resonance imaging-based study, we investigated the clinical features, neuroimaging features and therapeutic outcomes of 14 adults (eight men and six women; mean age 60.4 years; range 37-77 years) with septic cavernous sinus thrombosis (CST). Of the underlying conditions, 10 had diabetes mellitus and 13 had concomitant sphenoid sinusitis. Headache (n = 13) and ophthalmoplegia (n = 13) were the most common clinical presentations, followed by fever (n = 9) and other neuro-vascular signs and symptoms. The duration from the onset of symptoms to diagnosis ranged from 1 to 61 days, and more than 64% (9/14) of the septic CST patients were diagnosed >7 days after symptom onset. Expansion of the cavernous sinus was the most common neuroimaging feature, followed by convexity of the lateral wall of the cavernous sinus (5) and filling defect of the cavernous sinus (4). Staphylococcal species (spp.) was the most commonly implicated pathogen, followed by Aspergillus spp. Despite treatment, 7% (1/14) of the patients died in the hospital and 67% (8/12) of the survivors had neurological deficits. The duration of onset-to-diagnosis and the presence of hemiparesis were significant prognostic factors. These results provide a preliminary view of this uncommon infectious syndrome. Further large-scale studies are needed to better delineate septic CST in adults.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico , Trombose do Corpo Cavernoso/microbiologia , Adulto , Idoso , Anti-Infecciosos/uso terapêutico , Trombose do Corpo Cavernoso/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015249

RESUMO

We present a novel treatment with the use of intraventricular antibiotics delivered through a ventriculostomy in a patient who developed septic cavernous sinus thrombosis after sinus surgery. A 65-year-old woman presented with acute on chronic sinusitis. The patient underwent a diagnostic left maxillary antrostomy, ethmoidectomy, sphenoidotomy and sinusotomy. Postoperatively, the patient experienced altered mental status with episodic fever despite treatment with broad-spectrum antimicrobial therapy. MRI of the brain showed extensive meningeal enhancement with the involvement of the right trigeminal and abducens nerve along with thick enhancement along the right pons and midbrain. MR arteriogram revealed a large filling defect within the cavernous sinus. Intraventricular gentamicin was administered via external ventricular drain (ie, ventriculostomy) every 24 hours for 14 days with continued treatment of intravenous ceftriaxone and metronidazole. The patient improved with complete resolution of her cavernous sinus meningitis on repeat brain imaging at 6 months posthospitalisation.


Assuntos
Trombose do Corpo Cavernoso/microbiologia , Trombose do Corpo Cavernoso/cirurgia , Seio Cavernoso/microbiologia , Ventriculostomia/métodos , Administração Intravenosa , Assistência ao Convalescente , Idoso , Angiografia/métodos , Antibacterianos/uso terapêutico , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/patologia , Trombose do Corpo Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/tratamento farmacológico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Injeções Intraventriculares/métodos , Imageamento por Ressonância Magnética/métodos , Meningite/diagnóstico por imagem , Meningite/tratamento farmacológico , Meningite/microbiologia , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Sinusite/complicações , Sinusite/cirurgia , Resultado do Tratamento
6.
Int J Infect Dis ; 82: 30-32, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30818047

RESUMO

Borrelia crocidurae is endemic in West Africa, where it represents the leading cause of tick-borne relapsing fever (TBRF). TBRF typically presents with high fever and systemic symptoms, followed by recurrent episodes. Neurological complications may occur during febrile relapses. B. crocidurae is considered the most neurotropic agent of TBRF and is associated to severe neurological manifestations i.e. meningitis and encephalitis. To date, European cases of B. crocidurae infection have been reported in travelers returning from endemic areas. We report the first autochthonous case in Europe of B. crocidurae infection, presenting as meningitis with cranial polyneuritis and cavernous sinus thrombosis that were not preceded by classic febrile recurrences.


Assuntos
Borrelia/isolamento & purificação , Trombose do Corpo Cavernoso/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Meningite/diagnóstico por imagem , Neurite (Inflamação)/diagnóstico por imagem , Febre Recorrente/diagnóstico por imagem , Adulto , Animais , Borrelia/genética , Trombose do Corpo Cavernoso/microbiologia , Encefalite/microbiologia , Europa (Continente) , Feminino , Humanos , Meningite/microbiologia , Pessoa de Meia-Idade , Neurite (Inflamação)/microbiologia , Febre Recorrente/microbiologia
7.
J Forensic Sci ; 63(6): 1888-1891, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29464700

RESUMO

Septic cavernous sinus thrombosis (SCST) is an uncommon consequence of head and face infection, but a rare complication after craniofacial fracture. In this case, SCST developed in a 13-year-old girl following a minor fall during volleyball, with impact and resulting abrasive contusion of the left forehead. She developed watery rhinorrhea, progressive headache, fever, nausea, vomiting, and left proptosis with blurred vision, and was admitted to hospital 3 days after injury. Drowsiness, high-grade fever, severe headache, left ocular pain with marked periorbital swelling, and paralysis of extraocular eye movements developed. Computed tomography scan identified left sphenoid and ethmoid sinusitis, a posterior clinoid fracture, and septic cavernous sinus thrombosis. She died after 10 days of in-hospital antibiotic therapy. Death was due to Staphylococcus aureus sepsis with septic pulmonary thromboemboli due to suppurative meningitis and cerebral infarction, due to SCST following apparently minor blunt head injury from an accidental fall.


Assuntos
Acidentes por Quedas , Trombose do Corpo Cavernoso/patologia , Testa/lesões , Infecções Estafilocócicas/complicações , Adolescente , Trombose do Corpo Cavernoso/microbiologia , Evolução Fatal , Feminino , Humanos , Meningoencefalite/microbiologia , Insuficiência de Múltiplos Órgãos/etiologia , Trombose/microbiologia , Trombose/patologia , Voleibol/lesões
8.
Orbit ; 37(2): 94-96, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29040036

RESUMO

An 86-year-old patient was hospitalized for fever and left acute orbital syndrome (red eye with moderate visual impairment, chemosis, ophthalmoplegia without proptosis, or any fundus involvement). CT scan showed superior ophthalmic vein and cavernous sinus enlargement complicating ipsilateral sphenoidal sinusitis. Magnetic resonance imaging (MRI) demonstrated the left cavernous sinus thrombosis extended to the ipsilateral jugular vein and transversal sinus (Lemierre syndrome). Intravenous broad-spectrum antibiotics and curative anticoagulation were prescribed. Blood cultures allowed the identification of Streptococcus intermedius and Staphylococcus warneri species. Evolution was favorable and the patient was discharged 3 weeks after. Antibiotics and anticoagulation were carried out for a total duration of 4 and 12 weeks, respectively. Lemierre syndrome is a potentially life-threatening emergency rarely encountered; thus, ophthalmologists should be cognizant of clinical and radiological features. Broad-spectrum antibiotics are the mainstay of treatment. Curative anticoagulation may be added if no blood coagulation disorder nor bleeding on neuroimaging has been identified.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico por imagem , Veias Jugulares/patologia , Síndrome de Lemierre/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Trombose do Corpo Cavernoso/tratamento farmacológico , Trombose do Corpo Cavernoso/microbiologia , Humanos , Síndrome de Lemierre/tratamento farmacológico , Síndrome de Lemierre/microbiologia , Imageamento por Ressonância Magnética , Masculino , Doenças dos Seios Paranasais/tratamento farmacológico , Doenças dos Seios Paranasais/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus intermedius/isolamento & purificação , Tomografia Computadorizada por Raios X
9.
Vestn Otorinolaringol ; 82(6): 72-76, 2017.
Artigo em Russo | MEDLINE | ID: mdl-29260788

RESUMO

The present review was designed to represent modern views of the problem of etiopathogenesis, clinical features, diagnostics, and treatment of septic thrombus of the cavernous sinus with special reference to the currently available methods for the detection and management of this condition.


Assuntos
Antibacterianos/farmacologia , Anticoagulantes/farmacologia , Trombose do Corpo Cavernoso , Trombose do Corpo Cavernoso/diagnóstico , Trombose do Corpo Cavernoso/microbiologia , Trombose do Corpo Cavernoso/terapia , Quimioterapia Combinada/métodos , Intervenção Médica Precoce , Humanos , Angiografia por Ressonância Magnética/métodos , Prognóstico , Tomografia Computadorizada por Raios X/métodos
10.
Infect Dis (Lond) ; 49(9): 641-646, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28535728

RESUMO

Cavernous sinus thrombosis (CST) is a severe disease which can result from infection of any of the tissues drained by the cavernous sinus. We here review eight cases, including a 12-year-old girl, all secondary to sphenoid sinusitis. The clinical manifestations, laboratory data, imaging findings, pathogens, medications, surgical treatment and clinical outcomes were analyzed. All eight patients had headache and five of them fever. All cases were associated with one or more ophthalmic symptoms. In four cases, computed tomography/magnetic resonance imaging showed isolated sphenoid sinusitis. In three cases, streptococci were isolated from blood culture and two cases showed Staphylococcus aureus in blood and sinus cultures. In seven cases, surgery was undertaken. All eight subjects received antibiotics, and 5 were administered intravenous ceftriaxone and metronidazole. Six subjects received anticoagulation therapy and one received corticosteroids. No mortality was recorded. Three cases showed sequelae, including Lemierre syndrome, ophthalmic complaints, and cranial nerve paralysis. In conclusion, the management of CST should include intravenous antibiotic therapy, combined with endonasal sinus surgery.


Assuntos
Trombose do Corpo Cavernoso/etiologia , Trombose do Corpo Cavernoso/terapia , Sinusite Esfenoidal/complicações , Infecções Estafilocócicas/complicações , Infecções Estreptocócicas/complicações , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/efeitos dos fármacos , Seio Cavernoso/microbiologia , Seio Cavernoso/cirurgia , Trombose do Corpo Cavernoso/diagnóstico , Trombose do Corpo Cavernoso/microbiologia , Criança , Feminino , Humanos , Síndrome de Lemierre/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Sinusite Esfenoidal/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Can J Ophthalmol ; 51(2): e75-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27085286
15.
J AAPOS ; 19(4): 358-62, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26239205

RESUMO

PURPOSE: To review the causes, treatment, and outcomes of cavernous sinus thrombosis (CST) in children. METHODS: The medical records of children (<18 years of age) diagnosed with thrombophlebitis of an intracranial venous sinus were reviewed to identify cases of CST presenting to Children's Hospital Colorado from January 2000 through January 2013. Cases were evaluated for etiology, symptoms, imaging characteristics, treatment, and outcomes. RESULTS: A total of 110 children with a venous thrombus of an intracranial sinus were included. Of these, 9 had a CST. All cases were confirmed by magnetic resonance imaging. All 9 had sinusitis, 4 had orbital involvement, and 1 resulted from a nasal septal abscess. Eight cases presented with ophthalmoplegia, and 5 presented with decreased vision. Every patient underwent sinus surgery: 4 underwent orbitotomy for abscess drainage, and 1 required bilateral exenteration. Cultures were inconclusive in 2 cases, and 2 cases were culture positive rhino-orbital mucormycosis. There was 1 case of methicillin-resistant Staphylococcus aureus. Of the 9 cases, 4 returned to normal vision and ocular motility; 5 had permanent ophthalmoplegia and vision loss. There were no cases of mortality. CONCLUSIONS: CST is a rare complication of orbital and sinus disease. High clinical suspicion, early neurologic imaging, and a multidisciplinary approach to management are key factors in reducing morbidity and mortality from CST in children.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Celulite Orbitária/diagnóstico , Sinusite/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Trombose do Corpo Cavernoso/microbiologia , Trombose do Corpo Cavernoso/terapia , Criança , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/terapia , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/terapia , Feminino , Humanos , Tempo de Internação , Imageamento por Ressonância Magnética , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Mucormicose/diagnóstico , Mucormicose/microbiologia , Mucormicose/terapia , Procedimentos Cirúrgicos Oftalmológicos , Celulite Orbitária/microbiologia , Celulite Orbitária/terapia , Sinusite/microbiologia , Sinusite/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico , Trombose Venosa/microbiologia , Trombose Venosa/terapia , Acuidade Visual/fisiologia
17.
Orbit ; 34(4): 175-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25955309

RESUMO

Infectious intracranial aneurysm and cavernous sinus thrombosis are rare complications of orbital cellulitis. We report the case of a 46-year-old male presenting with sinusitis and orbital cellulitis complicated by the development of an orbital mass. Following orbitotomy with debulking, the patient underwent bony orbital decompression for increasing proptosis postoperatively. While his exam stabilized, the patient developed complete ptosis and extraocular motor palsy in the contralateral eye after undergoing bilateral sinus debridement. Imaging was notable for the presence of a pseudoaneurysm of the internal carotid artery, which was treated with a stent. This report demonstrates rare complications of orbital cellulitis. These patients should be monitored carefully with noninvasive imaging studies, such as cerebral angiography, for early detection of vascular abnormalities that can progress rapidly.


Assuntos
Trombose do Corpo Cavernoso/etiologia , Trombose do Corpo Cavernoso/microbiologia , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/microbiologia , Celulite Orbitária/complicações , Celulite Orbitária/cirurgia , Trombose do Corpo Cavernoso/diagnóstico por imagem , Desbridamento , Descompressão Cirúrgica , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Celulite Orbitária/diagnóstico por imagem , Radiografia , Sinusite/complicações , Sinusite/diagnóstico por imagem , Sinusite/cirurgia
18.
BMJ Case Rep ; 20142014 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-25425249

RESUMO

We report a rare case of acute, septic cavernous sinus thrombosis (SCST) caused by tuberculosis infection. The diagnosis of SCST was suspected and rapidly confirmed based on high fever, dramatic and typical signs of left cranial nerve paralysis and the result of digital subtraction angiography after the onset of the disease. However, the diagnosis of tuberculosis infection was missed, and the 55-year-old patient was treated with high-dose glucocorticoid, anticoagulants and a series of intravenous antibiotics for bacteria. His symptoms failed to improve, and steroid treatment resulted in serious haematogenous dissemination of Mycobacterium tuberculosis, including miliary tuberculosis and tuberculosis verrucosa cutis, which led to the final diagnosis. Then, the patient received a five-agent antituberculosis treatment. He was recently followed up with only the sequelae of left side ptosis and oculomotor weakness.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico , Trombose do Corpo Cavernoso/microbiologia , Tuberculose Cutânea/complicações , Tuberculose Miliar/complicações , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Miliar/tratamento farmacológico
19.
BMJ Case Rep ; 20142014 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-24842357

RESUMO

We report a case of cavernous sinus thrombosis in a 55-year-old Chinese man who presented with headache, ophthalmoplegia and ptosis. Campylobacter rectus was eventually isolated from the blood cultures. He was treated with broad-spectrum antibiotics, anticoagulation and steroids with improvement in his condition. To our knowledge, this is the first documented case of septic cavernous sinus thrombosis caused by C. rectus.


Assuntos
Bacteriemia/diagnóstico , Infecções por Campylobacter/diagnóstico , Campylobacter rectus/isolamento & purificação , Trombose do Corpo Cavernoso/diagnóstico , Trombose do Corpo Cavernoso/microbiologia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções por Campylobacter/tratamento farmacológico , Trombose do Corpo Cavernoso/tratamento farmacológico , Meios de Contraste , Quimioterapia Combinada , Seguimentos , Humanos , Aumento da Imagem/métodos , Infusões Intravenosas , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Doenças Raras , Esteroides/uso terapêutico , Viagem , Resultado do Tratamento
20.
J Oral Maxillofac Surg ; 71(11): 1899.e1-1899.e5, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23945514

RESUMO

Cavernous sinus thrombosis (CST) is a rare disease with the potential for significant morbidity and even death. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. The cause may be aseptic or infectious. When the cause is infectious in nature, it is most commonly from a bacterial origin. However, we present the case of a 57-year-old man with a fungally related CST that ultimately led to his death.


Assuntos
Aspergilose/diagnóstico , Trombose do Corpo Cavernoso/microbiologia , Cegueira/microbiologia , Diagnóstico Diferencial , Paralisia Facial/microbiologia , Evolução Fatal , Humanos , Masculino , Sinusite Maxilar/microbiologia , Pessoa de Meia-Idade , Celulite Orbitária/microbiologia
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