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Septic cavernous sinus thrombosis with diffuse spread leading to cerebral ischemia
Pooja Sethi1, Scott T Jones, Alejandra A Valenzuela
1Department of Ophthalmology, Tulane Medical School, New Orleans , Louisiana , USA.
Orbit (Amsterdam, Netherlands)
|August 6, 2013
Summary
Septic cavernous sinus thrombosis (CST) is a rare, fatal condition. A nasal furuncle led to rapid, severe CST with multi-system organ failure and death despite aggressive treatment.
Area of Science:
- Neurology
- Ophthalmology
- Infectious Disease
Background:
- Septic cavernous sinus thrombosis (CST) is a rare condition with diverse causes and varied presentations.
- High mortality rates are associated with CST due to its potential for rapid progression.
Observation:
- A 25-year-old male with a nasal furuncle presented with acute symptoms including fixed, dilated pupils, bilateral exophthalmos, and unresponsiveness.
- Ophthalmoscopic examination revealed septic emboli in the left eye and retinal detachment in the right eye.
- MRI/MRV demonstrated extensive thrombosis in the cavernous sinuses, sigmoid dural sinuses, and internal jugular veins, alongside cerebral edema and venous infarction.
Findings:
- Blood cultures identified Methicillin-resistant Staphylococcus aureus (MRSA).
- The patient experienced multi-system organ failure.
- Despite anticoagulation and antibiotics, the patient suffered cardiopulmonary arrest and expired.
Implications:
- Rapidly progressing CST, particularly with MRSA, carries a grave prognosis.
- Early recognition and aggressive management are critical, though outcomes remain poor.
- This case highlights the severe risks associated with seemingly minor infections like nasal furuncles in the context of CST.
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