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Early cavernous sinus thrombosis following unilateral pansinusitis in a child
Ajay Mallick1, Som Dutt Pathak1, Sandeep Shankar2
1Department of ENT, Command Hospital, Kolkata, West Bengal, India.
Insights
Cavernous sinus thrombosis (CST) is a serious condition. Early detection and treatment of CST following sinusitis can lead to rare, complete recovery without neurological deficits.
Area of Science:
- Neurology
- Infectious Diseases
- Otolaryngology
Background:
- Cavernous sinus thrombosis (CST) is a rare but life-threatening complication of head and neck infections.
- Prompt diagnosis and aggressive management are crucial to prevent severe neurological disability and mortality.
Observation:
- A 12-year-old female presented with unilateral pansinusitis, rapidly progressing to bilateral cavernous sinus thrombosis.
- Initial symptoms included headache and retro-orbital pain disproportionate to physical findings, raising suspicion for CST.
Findings:
- Despite early medical treatment, the patient developed bilateral cranial nerve paresis.
- Sustained antibiotic and anticoagulation therapy resulted in successful management with no residual neurological deficits.
Implications:
- This case underscores the critical importance of high clinical suspicion for cavernous sinus involvement in patients with sinusitis.
- It highlights the potential for complete neurological recovery even in severe cases of CST with timely and persistent intervention.
Abstract:
Cavernous sinus thrombosis (CST) is a life-threatening entity with a high rate of mortality and lifelong morbidity. A strong clinical suspicion of the complication, early radiological detection and institution of timely, aggressive treatment are required to prevent permanent neurological disability. We present a 12-year-old girl with bilateral CST following unilateral pansinusitis. Clinical symptoms of headache and retro-orbital pain out of proportion to clinical signs on presentation prompted a suspicion of something beyond sinusitis and raised the clinical suspicion of cavernous sinus involvement. In spite of institution of an early medical treatment, she progressed to develop bilateral cranial nerve paresis. However, with the persistence of antibiotics and anticoagulation therapy, she was successfully managed with no residual neurological sequelae. The aim of this presentation is to highlight the grave consequences of cavernous sinus involvement following infections of paranasal sinus and the rare complete recovery from disability in this case.
