Septic Cavernous Sinus Thrombosis Following a Minor Head Injury: A Rare Cause of Medico-Legal Death

Septic cavernous sinus thrombosis (SCST) is an uncommon consequence of head and face infection, but a rare complication after craniofacial fracture. In this case, SCST developed in a 13-year-old girl following a minor fall during volleyball, with impact and resulting abrasive contusion of the left forehead. She developed watery rhinorrhea, progressive headache, fever, nausea, vomiting, and left proptosis with blurred vision, and was admitted to hospital 3 days after injury. Drowsiness, high-grade fever, severe headache, left ocular pain with marked periorbital swelling, and paralysis of extraocular eye movements developed. Computed tomography scan identified left sphenoid and ethmoid sinusitis, a posterior clinoid fracture, and septic cavernous sinus thrombosis. She died after 10 days of in-hospital antibiotic therapy. Death was due to Staphylococcus aureus sepsis with septic pulmonary thromboemboli due to suppurative meningitis and cerebral infarction, due to SCST following apparently minor blunt head injury from an accidental fall.