Oculomotor synkinesis: an uncommon sequela of paediatric cavernous sinus thrombosis

Area of Science:

• Neurology
• Ophthalmology
• Pediatrics

Background:

• Cavernous sinus thrombosis is a rare but serious condition, often associated with infections near the eye or nose.
• Orbital cellulitis can be a presenting sign of underlying cavernous sinus thrombosis, particularly in children.
• Oculomotor synkinesis, or aberrant regeneration of the third cranial nerve, typically results from nerve injury.

Observation:

• A 4-year-old boy presented with periorbital swelling and ptosis following a febrile illness and nasal furuncle.
• Initial imaging suggested orbital cellulitis, but further MRI revealed cavernous sinus and superior ophthalmic vein thrombosis.
• The patient experienced significant improvement in ocular motility and ptosis after treatment with antibiotics and anticoagulants.

Findings:

• Despite initial recovery, the child later developed oculomotor synkinesis, indicating aberrant regeneration of the oculomotor nerve.
• This case highlights an unusual sequela of cavernous sinus thrombosis in a pediatric patient.
• The development of synkinesis suggests that the initial insult to the third cranial nerve during thrombosis led to abnormal nerve regrowth.

Implications:

• This case underscores the importance of thorough investigation for cavernous sinus thrombosis in children presenting with orbital inflammatory signs.
• It expands the known spectrum of neurological complications following cavernous sinus thrombosis.
• Understanding the long-term sequelae, such as oculomotor synkinesis, is crucial for managing pediatric patients post-thrombosis and for predicting functional outcomes.