Septic Cavernous Sinus Thrombosis Caused by Sinusitis

By Ichwan, Brian MD; Barrie, Michael MD; Neltner, Kurt MD A 37-year-old man with no significant medical history presented to the emergency department with a headache. He described it as an insidious, constant severe pain that was initially localized occipital but progressed to a bitemporal distribution. His neurologic exam, extraocular movements, and visual acuity were all normal. The patient was given symptomatic treatment with compazine and Benadryl. He was responsive to therapy and discharged home after his headache symptoms resolved.   Seven days later, however, he presented to the emergency department with a worsening headache, progressive altered mental status, fever, and bilateral proptosis. His temperature was of 103.9°F, blood pressure was 194/82 mm Hg, pulse rate was 87 bpm, and oxygen saturation was 98%. His exam was significant for profound bilateral periorbital edema with significant chemosis, drainage, and overlying erythema. (Figure 1.)     The right eye was impossible to examine because of significant swelling. The extraocular muscles in the left eye were limited in all directions, and pupils were sluggish. Computed tomography without contrast of the head and orbit demonstrated an enlargement of the right superior ophthalmic vein, attenuation of the right sigmoid sinus, subtentorial collection, paranasal sinus disease, and severe bilateral proptosis with periorbital soft tissue swelling. (Figure 2.) The patient was treated empirically with intravenou...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research