Bilateral cavernous sinus thrombosis complicating acute unilateral pansinusitis in a 15-year-old boy

BMJ Case Rep. 2020 Dec 22;13(12):e237758. doi: 10.1136/bcr-2020-237758.

Abstract

Cavernous sinus thrombosis (CST) is a rare and potentially fatal complication of acute sinusitis. Timely diagnosis and management is, therefore, essential in preventing death and neurological disability. Here, we describe the case of a paediatric patient with bilateral CST secondary to acute unilateral pansinusitis that presented with rapidly progressing bilateral periorbital oedema. Initial imaging was negative. This case serves to emphasise the importance of maintaining a high index of suspicion when managing paediatric patients with suspected CST with persistent symptoms. Expeditious investigation and management of our patient in this case resulted in a positive outcome, with resolution of symptoms and no residual neurological deficit.

Keywords: ear; nose and throat/otolaryngology; radiology; venous thromboembolism.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Adolescent
  • Anti-Bacterial Agents / administration & dosage
  • Anticoagulants / administration & dosage
  • Cavernous Sinus / diagnostic imaging
  • Cavernous Sinus / microbiology*
  • Cavernous Sinus / pathology
  • Cavernous Sinus / surgery
  • Cavernous Sinus Thrombosis / cerebrospinal fluid
  • Cavernous Sinus Thrombosis / diagnosis*
  • Cavernous Sinus Thrombosis / drug therapy
  • Cavernous Sinus Thrombosis / etiology
  • Diagnosis, Differential
  • Drug Therapy, Combination / methods
  • Endoscopy
  • Headache / cerebrospinal fluid
  • Headache / etiology*
  • Headache / therapy
  • Humans
  • Magnetic Resonance Angiography
  • Male
  • Sinusitis / complications
  • Sinusitis / diagnosis*
  • Sinusitis / microbiology
  • Sinusitis / therapy
  • Streptococcal Infections / complications
  • Streptococcal Infections / diagnosis*
  • Streptococcal Infections / microbiology
  • Streptococcal Infections / therapy
  • Streptococcus intermedius / isolation & purification
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Anticoagulants