title: Septic cavernous sinus thrombosis complicated by occlusion of the internal carotid artery and multiple embolic strokes after surgery of an anorectal abscess: a clinical chameleon.
abstract: BACKGROUND
  Septic thrombosis of the cavernous sinus (CST) is a rare and potentially life-threatening condition mostly caused by facial or ear, nose, and throat infections. Anatomic structures in vicinity of the cavernous sinus are thereby susceptible to inflammatory damage. In particular nervous system structures are almost regularly affected; however, only few authors reported severe involvement of the internal carotid artery (ICA).
  
  
  METHODS
  We present an atypical clinical course of CST in a 61-year-old male diabetic patient caused by a distant focus of inflammation. Septic CST after surgical treatment of an anorectal abscess was complicated by occlusion of the ICA and multiple embolic strokes. The diagnosis was established by magnetic resonance imaging scan, symptoms resolved after antibiotic therapy and heparin anticoagulation.
  
  
  CONCLUSIONS
  The presented case and review of literature emphasizes the variability of signs and clinical course of CST, a frequent cause of delayed diagnosis. Especially in immunocompromised patients, the primary source of CST may be a distant inflammatory focus with nonspecific and subacute symptoms. Septic CST can be a rare cause of ischemic stroke when complicated by ICA occlusion because of septic arteritis. Expedited diagnostic workup is necessary and rests upon radiologic investigations.
authors.affiliation: Department of Neurology, University of Muenster, Muenster, Germany. sonjasuntrup@uni-muenster.de
authors.forename: Sonja
authors.initials: S
authors.lastname: Suntrup
authors.forename: Andre
authors.initials: A
authors.lastname: Kemmling
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederstadt
authors.forename: Martin A
authors.initials: MA
authors.lastname: Ritter
mesh_terms: D000038:Abscess / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications* / Q000473:pathology; D020226:Cavernous Sinus Thrombosis / Q000150:complications* / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000601:surgery*; D020521:Stroke / Q000150:complications* / Q000473:pathology