title: Septic cavernous sinus thrombosis with diffuse spread leading to cerebral ischemia.
abstract: BACKGROUND
  Septic cavernous sinus thrombosis (CST) is a rare disease with many etiologies and a diffuse array of initial presentation leading to high mortality.
  
  
  METHODS
  A 25-year-old male with a history of a nasal furuncle presents with an acute onset of fixed and dilated pupils, bilateral exophthalmos, hemorrhagic chemosis, elevated intraocular pressures, restricted extraocular motility, and unresponsiveness. A retinal septic emboli in the left eye is present on dilated fundoscopic exam while an exudative retinal detachment is present in the right eye. MRI/MRV revealed extensive thrombosis of cavernous sinuses, distal sigmoid dural sinuses, and proximal internal jugular veins with associated cerebral edema and multifocal areas of venous infarction. Blood cultures grew Methicillin-resistant Staphylococcus aureus and the patient suffered multi-system organ failure. Despite treatment with full dose systemic anticoagulation and broad spectrum antibiotics the patient suffered a cardiopulmonary arrest and expired.
  
  
  CONCLUSIONS
  The acuity of onset coupled with the multiple risk factors for septic cavernous sinus thrombosis in this patient led to a fulminant presentation of this disease and ultimate poor outcome.
authors.affiliation: Department of Ophthalmology, Tulane Medical School, New Orleans , Louisiana , USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Sethi
authors.forename: Scott T
authors.initials: ST
authors.lastname: Jones
authors.forename: Alejandra A
authors.initials: AA
authors.lastname: Valenzuela
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000209:etiology*; D020226:Cavernous Sinus Thrombosis / Q000150:complications*; D017809:Fatal Outcome; D005667:Furunculosis / Q000150:complications* / Q000382:microbiology; D006801:Humans; D008297:Male