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[Case of aseptic primary cavernous sinus thrombosis]
No to Shinkei = Brain and Nerve
|September 1, 1983
Summary
A rare case of aseptic primary cavernous sinus thrombosis (CST) presented with unusual intraorbital congestion. Diagnosis was confirmed through advanced imaging and clinical evaluation.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Imaging
Background:
- Cavernous sinus thrombosis (CST) is categorized as aseptic or septic.
- Aseptic CST comprises primary (unknown etiology) and secondary types.
- Primary aseptic CST is exceptionally rare, particularly with initial intraorbital symptoms.
Observation:
- A 64-year-old male presented with left eye exophthalmos and conjunctival congestion.
- Clinical signs included ophthalmoplegia, choked disc, retinal vein thrombosis, and hemorrhage.
- Blood tests showed mild anemia and elevated ESR; thyroid studies were normal.
Findings:
- Carotid angiography revealed occlusion of the Sylvian vein and cavernous sinus.
- Orbital and jugular venography confirmed occlusion of the superior ophthalmic vein, cavernous sinus, and inferior petrosal sinus.
- CT scans demonstrated parasellar enhancement and hypertrophy of ocular muscles and the optic nerve.
Implications:
- This case highlights the diverse initial presentations of aseptic primary CST.
- Advanced imaging techniques are crucial for diagnosing rare vascular occlusive events.
- Understanding atypical presentations aids in timely diagnosis and management of cavernous sinus thrombosis.