title: Cavernous sinus thrombosis complicating sinusitis.
abstract: BACKGROUND
  Septic cavernous sinus thrombosis is a rare complication of paranasal sinusitis.
  
  
  OBJECTIVE
  To familiarize the clinician with the pathogenesis, diagnosis, and appropriate management of septic cavernous sinus thrombosis.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  Pediatric intensive care unit in a university hospital.
  
  
  METHODS
  We present a 12-yr-old female with a 1 wk history of an upper respiratory tract infection with worsening dyspnea, cough, and swelling of the left eye progressing to adult respiratory distress syndrome. Secondary to the need for significant mechanical ventilatory support, venovenous extracorporeal membrane oxygenation was initiated. Computed tomography scan of the head and neck with contrast revealed bilateral cavernous sinus thrombosis. After broad-spectrum intravenous antibiotics and aggressive supportive care in conjunction with surgical intervention (maxillary sinus lavage and right orbital exploration) and anticoagulation therapy, the patient recovered. Blood cultures were positive for Viridans streptococcus. At discharge 3 wks later, the patient had improved, but had right-eye blindness.
  
  
  CONCLUSIONS
  The diagnosis of septic cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging; early diagnosis and surgical drainage of the underlying primary source of infection in conjunction with long-term intravenous antibiotic therapy are critical for an optimal clinical outcome.
authors.affiliation: Department of Anesthesiology, Wake Forest University School of Medicine and Brenner Children's Hospital, Winston-Salem, NC, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Cannon
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Antonio
authors.forename: John J
authors.initials: JJ
authors.lastname: McCloskey
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hines
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Tobin
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Shetty
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D020226:Cavernous Sinus Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012852:Sinusitis / Q000150:complications*; D013290:Streptococcal Infections; D034363:Viridans Streptococci
chemical_list: D000900:Anti-Bacterial Agents