Septic cavernous sinus thrombosis: an unusual and fatal disease.
BACKGROUND
Septic cavernous sinus thrombosis (CST) is a rare and fatal disease. Clinical presentations in the early stage are nonspecific, and the sensitivity of cranial axial computed tomography (CT) with thick section is low. This study analyzed the clinical manifestation and neuroimaging findings in patients with septic CST in a medical center in Taiwan.


METHODS
This retrospective case series included nine patients with septic CST who had typical symptoms and clinical course, evidence of infection, and imaging studies which demonstrated cavernous sinus lesion, and who were treated between 1995 and 2003 at National Taiwan University Hospital.


RESULTS
Seven (77.8 %) patients were more than 50 years old. Five (55.6%) had diabetes, and three (33.3%) had hematologic diseases. All cases were associated with paranasal sinusitis. The most frequent initial symptom was headache (66.7%), followed by ophthalmic complaints (diplopia or ophthalmoplegia, 55.6%; blurred vision or blindness, 55.6%), and ptosis (44.4%). Initial cranial images failed to identify CTS in all patients. Subsequent magnetic resonance imaging (MRI) or coronal contrast-enhanced CT (CECT) with thin section confirmed the diagnosis. Fungi were the most common pathogens (55.6%). The inhospital case-fatality rate was high (44.4%).


CONCLUSIONS
Due to the high case-fatality rate and low yield rate of blood cultures, fungal CST should be suspected in an immunocompromised patient with ophthalmic complaints that progress from one eye to the other. Coronal thin-section CECT may be a useful alternative to MRI as a diagnostic modality for this condition.
Chen
Huan-Wen
HW
Department of Internal Medicine, Lo-Tung Pohai Hospital, Yilan, Taiwan.
Su
Chan-Ping
CP
Su
Deng-Huang
DH
Chen
Huan-Wu
HW
Chen
Yee-Chun
YC
D000293:Adolescent; D000328:Adult; D000368:Aged; D020226:Cavernous Sinus Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D048909:Diabetes Complications; D005260:Female; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome