Septic cavernous sinus thrombosis secondary to halo vest pin site infection

Abstract

Background: Pin site infection is one of the frequent complications of the halo crown application which can be easily handled if addressed early. However, if this issue is neglected then serious infectious events may quickly transpire. Among all of the medical literature that the previously described scenarios have illuminated; we did not encounter a case involving infectious cavernous sinus thrombosis.

Case description: The authors present a middle age man who arrived at our clinic with an acute left peri-orbital swelling, proptosis, and ophthalmoplegia which had occurred subsequent to an untreated halo pine site infection. With a diagnosis of septic cavernous sinus thrombosis (CST), appropriate antibiotics and anticoagulant therapies were administered.

Outcome: With the continuation of this conservative treatment regimen, he was successfully managed with no residual neurological consequences.

Conclusion: Halo vest orthosis is an appropriately tolerated upper cervical spinal stabilizing device that is a commonly used worldwide. Septic CST that is secondary to a halo vest pin site infection has not been previously described within medical literature. In the case of a neglected pin site infection, with demonstration of ipsilateral eyelid edema and proptosis, septic CST should be immediately considered and treated vigorously with antibiotics and anticoagulant therapies.

Keywords: Anticoagulants; Cavernous sinus thrombosis; Halo vest orthosis; Upper cervical spine.

Fig. 1

Digital photograph two weeks after admission (a,b) showing a man with left eyelid edema, proptosis, and a ptosis and external deviation of the left, note the scars of pin sites (black arrow heads). (b) Note dilated pupil which is due to third nerve palsy.

Fig. 2

MR venogram showing enlarged left ophthalmic vein indicating the obstruction of the cavernous sinus.

Fig. 3

(a) In brain MR venography, there is no longer any engorgement and enlargement of ophthalmic vein present. (b) MRI of the brain shows the enlargement of left petrosal vein, note heterogeneous features inside this vein indicating a partial resorption of the thrombus and its recanalization (black arrow head).

Fig. 4

Digital photograph 4 months after the onset, (a–d) demonstrates the recovery of proptosis and ptosis. Note that eye movements in all directions are normalized.