title: Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves.
abstract: Lemierre's syndrome is characterized by anaerobic septicemia, internal jugular vein thrombosis, and septic emboli associated with infections of the head and neck. We describe an unusual and clinically confusing case of a young woman with an acute paresis of the abducens nerve and partial paresis of the right oculomotor nerve. After an extensive imaging diagnostic procedure, we also documented a peritonsillar abscess and various types of thromboses in intracranial and extracranial veins. Furthermore, we found brain and lung abscesses, which led us to establish the diagnosis of Lemierre's syndrome. Despite intensive anti-coagulation and antibiotic therapy, the patient developed a mycotic aneurysm in the right internal carotid artery directly adjacent to the previously thrombosed cavernous sinus. In summary, we were able to confirm that Lemierre's syndrome may occur in conjunction with uncharacteristic symptoms. Due to the sometimes confusing clinical symptoms as well as clinical and radiological specialties, we had to work on an interdisciplinary basis to minimize the delay prior to establishing the diagnosis and therapy.
authors.affiliation: Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland. andreas.gutzeit@ksw.ch
authors.forename: Andreas
authors.initials: A
authors.lastname: Gutzeit
authors.forename: Justus E
authors.initials: JE
authors.lastname: Roos
authors.forename: Bettina
authors.initials: B
authors.lastname: Portocarrero-Fäh
authors.forename: Carolin
authors.initials: C
authors.lastname: Reischauer
authors.forename: Lulian
authors.initials: L
authors.lastname: Claas
authors.forename: Karin
authors.initials: K
authors.lastname: Gassmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Hergan
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kos
authors.forename: Biliana
authors.initials: B
authors.lastname: Rodic
authors.forename: Kerstin
authors.initials: K
authors.lastname: Winkler
authors.forename: Urs
authors.initials: U
authors.lastname: Karrer
authors.forename: Sabine
authors.initials: S
authors.lastname: Sartoretti-Schefer
mesh_terms: D020434:Abducens Nerve Diseases / Q000175:diagnosis* / Q000209:etiology; D000208:Acute Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D057831:Lemierre Syndrome / Q000150:complications / Q000175:diagnosis*; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis* / Q000209:etiology; D010291:Paresis / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
keywords: Lemierre syndrome; abducens nerve paresis; oculomotor nerve paresis