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Cavernous Sinus Thrombosis

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Cavernous Sinus Thrombosis

Vinayak Deshmukh, Bhavana Lakhkar, Jayant Wagha.
Department of Pediatrics, JNMC, Wardha, India.
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Deshmukh V, Lakhkar B, Wagha J. Cavernous Sinus Thrombosis. Pediatr Oncall J. 2008;5: 105.

Address for Correspondence
Dr. Bhavana Lakhkar. Prof and HOD Pediatrics Dept. JNMC. Sawangi Meghe Wardha. 442002 India.
 
Abstract
Cavernous sinus thrombosis is a rare pediatric emergency. Early diagnosis and aggressive treatment are required to prevent morbidity and mortality. We present an 8 years old boy with cavernous sinus thrombosis.
 
Keywords
Cavernous Sinus Thrombosis, Proptosis, Ophthalmoplegia
 
Introduction
Cavernous sinus is an irregular shaped, endothelium lined venous space, on either side of sphenoid bone. It has wide connections to the veins around and the veins draining the face. Structures passing through the wall of cavernous sinus are internal carotid artery, abducens, oculomotor, trochlear nerve and divisions of trigeminal nerve. Cavernous sinus thrombosis is a serious life-threatening condition with a high mortality.
 
Case Report
An 8 year old boy came with the complaints of high grade fever since 2 days, severe pain, redness and swelling in and around the eyes along with diminution of vision in the right eye. Gradually he had pain, swelling and diminution of vision in the left eye as well. He had history of nasal discharge and headache since last 2 years. On examination, patient was toxic, febrile and had severe pain in the both eyes but more so in the right eye. There was congestion, chemosis of eyelids and conjunctiva, complete ophthalmoplegia, non-pulsatile proptosis and papilledema in both eyes. CT Scan of the brain showed a thrombus in the cavernous sinus along with abscess formation in the both orbital region and proptosis of right eye. (Figure 1). The child was treated with intravenous ampicillin and vancomycin with analgesics and low molecular weight heparin injection. He recovered slowly over next eight days. He was left behind with minimum vision in the right eye and almost 50% vision in the left eye.

1a: Enhancing infective focus between the medial rectus and the medial wall of orbit. Right eye shows proptosis. Changes of cellulitis are seen near the medial canthus.


1b: Left cavernous sinus appears normal where as the right cavernous sinus shows decreased size and a filling defect suggestive of a thrombus.
 
Discussion
Cavernous sinus thrombosis is a serious life threatening condition with a high mortality. It has been improved markedly because of an early awareness of the condition and prompt initiation of parenteral antibiotics (1). In our patient initially one eye was affected but due to intercavernous communication the other eye was also similarly affected.

Patients with cavernous sinus thrombosis present with hyperthermia, headache, vomiting, proptosis and involvement of the 3rd, 4th and 6th cranial nerves. It is usually a complication of a facial infection. CT Scan or MRI establishes the diagnosis. Septic cavernous sinus thrombosis has rarely been reported in children with variable outcome Allergic rhinitis, a neglected untreated nasal furuncle and paranasal sinusitis can lead to cavernous sinus thrombosis. (2-5)

The diagnosis of septic cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging; early diagnosis and surgical drainage of the underlying primary source of infection in conjunction with long-term intravenous antibiotic therapy are critical for an optimal clinical outcome. (6)
 
Funding
None
 
Conflict of Interest
None
 
References :
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  2. Canon ML, Antonio BL, McCloskey JJ, Hines MH, Tobin JR, Shetty AK. Cavernous sinus thrombosis complicating sinusitis. Pediatr Crit Care Med. 2004; 5: 86-8.  [CrossRef]
  3. Baidya K, Bhaduri G, Mondal LK, Mukherjee R, Singh M. Atypical presentation of a unilateral septic thrombosis of cavernous sinus. J Indian Med Assoc. 2005; 103: 437-8.  [PubMed]
  4. Radulescu L, Poita I, Curca IA, Martu D. Thrombophlebitis of left cavernous sinus secondary to acute right sphenoid sinusitis. Rev Med Chir Soc Med Nat Iasi. 2005; 109: 573-6.  [PubMed]
  5. Holzmann D, Willi U, Nadal D. Allergic rhinitis as a risk factor for orbital complication of acute rhinosinusitis in children. Am J Rhinol. 2001; 15(6): 387-90.  [CrossRef]
  6. Chacar-Rabay H, Hejeily RK, Aouad A. Cavernous sinus thrombosis. Late diagnosis and complications. J Med Liban. 1998; 46: 218-21.  [PubMed]

Last Updated : 01 May 2008 Vol 5 Issue 5 Art #19

Cite this article as: :
Deshmukh V, Lakhkar B, Wagha J. Cavernous Sinus Thrombosis. Pediatr Oncall J. 2008;5: 105.
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