title: Septic thrombosis of the cavernous sinus: two different mechanisms.
abstract: OBJECTIVE
  Septic thrombosis of the cavernous sinus is a rare condition that may lead to significant morbidity and mortality if not diagnosed and treated urgently. We present two recent cases of bilateral septic cavernous sinus thrombosis with differing etiologies, the first of dental origin and the second a complication of sphenoid sinusitis.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A diagnosis of cavernous sinus thrombosis was made based on clinical findings and confirmed by imaging in both patients. The etiology in the first patient was related to poor dental hygiene, with resultant spread of infection to the cavernous sinuses. The second had bilateral sphenoid sinusitis, with intravascular gas noted in both orbits and cavernous sinuses. This is the first reported occurrence of such an event associated with septic cavernous sinus thrombosis. Bilateral sphenoidotomies with evacuation of the sinuses were performed, and Haemophilus influenzae was cultured from the sphenoidotomy fluid and blood. Broad spectrum intravenous antibiotics were given in both patients, and complete recovery achieved within weeks.
  
  
  CONCLUSIONS
  In septic thrombosis of the cavernous sinus, early recognition and prompt management with broad spectrum intravenous antibiotics is crucial for full recovery. The primary source of sepsis may be a distant focus with septicemia preceding thrombosis of the cavernous sinus. Alternatively, infection may spread from facial regions via the facial venous plexus or from the sphenoid sinus directly to the adjacent cavernous sinus.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Pavlovich
authors.forename: Audrey
authors.initials: A
authors.lastname: Looi
authors.forename: Jack
authors.initials: J
authors.lastname: Rootman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D020226:Cavernous Sinus Thrombosis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006192:Haemophilus Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000008:administration & dosage; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000078222:Tinzaparin; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D010400:Penicillin G