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Case Reports
. 2019 Jan 29;12(1):e227302.
doi: 10.1136/bcr-2018-227302.

Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis

Christodoulos Dolapsakis  1 , Eleftheria Kranidioti  1 , Sofia Katsila  1 , Michael Samarkos  2   3
Affiliations
Case Reports

Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis

Christodoulos Dolapsakis et al. BMJ Case Rep. .

Abstract

We report a case of septic thrombosis of the right cavernous sinus in a diabetic woman in her late 70's due to ipsilateral sphenoid sinusitis. The diagnosis was delayed and made only after the abrupt and dramatic appearance of the manifestations of sinus thrombosis. The patient developed, among the other symptoms, right peripheral facial palsy, which is a very rare manifestation in cavernous sinus thrombosis (CST). She was treated with broad-spectrum antibiotics and enoxaparin. The day of the scheduled drainage of sphenoid sinus-24 hours after the initiation of anticoagulation-she developed fatal subarachnoid haemorrhage. Our case demonstrates the difficulty of timely diagnosis of acute sphenoid sinusitis which has emerged as the most common primary infectious source potentially leading in CST. It also underscores the uncertainty concerning the use of anticoagulation in cerebral sinus thrombosis of infectious origin.

Keywords: cranial nerves; ear, nose and throat/otolaryngology; infection (neurology); neuroimaging.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Anterior view of the right eye of the patient showing exophthalmos, chemosis and a fixed and dilated right pupil.
Figure 2
Figure 2
CT scan showing total opacification of the right sphenoid sinus and signs of inflammation of the ethmoidal and opposite sphenoidal sinuses.
Figure 3
Figure 3
MRI showing opacification of the right sphenoid sinus, dilated right superior ophthalmic vein and fullness of right cavernous sinus (arrows).
See this image and copyright information in PMC

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