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Ophthalmic manifestations and outcomes after cavernous sinus thrombosis in children
Garett S Frank1, Jesse M Smith1, Brett W Davies2
1Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora.
Insights
Cavernous sinus thrombosis (CST) in children is a rare but serious complication of sinus infections. Early diagnosis and multidisciplinary management are crucial for improving outcomes and preventing vision loss.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Infectious Diseases
Background:
- Cavernous sinus thrombosis (CST) is a rare but potentially devastating condition.
- It often arises as a complication of infections in the sinuses or orbit.
- Prompt recognition and management are vital to prevent severe morbidity.
Purpose of the Study:
- To review the causes, treatment, and outcomes of pediatric cavernous sinus thrombosis.
- To identify key factors influencing patient prognosis.
Main Methods:
- Retrospective review of medical records of children (<18 years) diagnosed with CST.
- Evaluation of etiology, symptoms, imaging, treatment, and outcomes.
- Cases identified at Children's Hospital Colorado from 2000-2013.
Main Results:
- Nine pediatric cases of CST were identified among 110 children with intracranial venous sinus thrombus.
- Sinusitis was the most common cause (9/9 cases), with orbital involvement in 4.
- Ophthalmoplegia and vision loss occurred in 8 and 5 patients, respectively; 5 had permanent deficits, but no mortality was observed.
Conclusions:
- Cavernous sinus thrombosis is a rare complication of orbital and sinus disease in children.
- High clinical suspicion, early neuroimaging, and a multidisciplinary approach are essential.
- Effective management can reduce morbidity and mortality associated with CST.
Purpose:
To review the causes, treatment, and outcomes of cavernous sinus thrombosis (CST) in children.
Methods:
The medical records of children (<18 years of age) diagnosed with thrombophlebitis of an intracranial venous sinus were reviewed to identify cases of CST presenting to Children's Hospital Colorado from January 2000 through January 2013. Cases were evaluated for etiology, symptoms, imaging characteristics, treatment, and outcomes.
Results:
A total of 110 children with a venous thrombus of an intracranial sinus were included. Of these, 9 had a CST. All cases were confirmed by magnetic resonance imaging. All 9 had sinusitis, 4 had orbital involvement, and 1 resulted from a nasal septal abscess. Eight cases presented with ophthalmoplegia, and 5 presented with decreased vision. Every patient underwent sinus surgery: 4 underwent orbitotomy for abscess drainage, and 1 required bilateral exenteration. Cultures were inconclusive in 2 cases, and 2 cases were culture positive rhino-orbital mucormycosis. There was 1 case of methicillin-resistant Staphylococcus aureus. Of the 9 cases, 4 returned to normal vision and ocular motility; 5 had permanent ophthalmoplegia and vision loss. There were no cases of mortality.
Conclusions:
CST is a rare complication of orbital and sinus disease. High clinical suspicion, early neurologic imaging, and a multidisciplinary approach to management are key factors in reducing morbidity and mortality from CST in children.
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