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An atypical presentation of cavernous sinus thrombosis
Y Ramanand1, T S Sidhu, K Jaswinder
1Dept. of Otorhinolaryngology, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Summary
Cavernous sinus thrombosis typically affects cranial nerves III, IV, and VI. This case presents an atypical form with facial nerve palsy and trigeminal nerve involvement in V2 and V3 branches.
Area of Science:
- Neurology
- Neuro-ophthalmology
- Infectious Diseases
Background:
- Cavernous sinus thrombosis (CST) is a rare but serious condition characterized by infection and clot formation within the cavernous sinus.
- Typical neurological deficits include palsies of the oculomotor (III), trochlear (IV), and abducens (VI) cranial nerves, and sensory disturbances in the ophthalmic division (V1) of the trigeminal nerve.
Observation:
- This report details a unique case of unilateral cavernous sinus thrombosis with an atypical clinical presentation.
- The patient exhibited ipsilateral lower motor neuron type facial nerve (VII) palsy, which has not been previously documented in CST literature.
- Additionally, the maxillary (V2) and mandibular (V3) branches of the trigeminal nerve were involved, extending beyond the typical V1 presentation.
Findings:
- The case highlights the potential for cavernous sinus thrombosis to manifest with a broader range of cranial nerve deficits than classically described.
- The presence of facial nerve palsy (VII) and involvement of V2/V3 branches represents a significant deviation from the typical CST syndrome.
- This atypical presentation underscores the importance of considering CST in the differential diagnosis of complex cranial nerve palsies.
Implications:
- This case expands the known spectrum of clinical manifestations for cavernous sinus thrombosis.
- It suggests that clinicians should maintain a high index of suspicion for CST even in the presence of unusual neurological findings.
- Further research may be warranted to understand the pathophysiology and diagnostic challenges associated with these atypical presentations of CST.
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