Septic cavernous sinus thrombosis

An unusual and fatal disease

Huan Wen Chen, Chan Ping Su, Deng Huang Su, Huan Wu Chen, Yee Chun Chen

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Septic cavernous sinus thrombosis (CST) is a rare and fatal disease. Clinical presentations in the early stage are nonspecific, and the sensitivity of cranial axial computed tomography (CT) with thick section is low. This study analyzed the clinical manifestation and neuroimaging findings in patients with septic CST in a medical center in Taiwan. Methods: This retrospective case series included nine patients with septic CST who had typical symptoms and clinical course, evidence of infection, and imaging studies which demonstrated cavernous sinus lesion, and who were treated between 1995 and 2003 at National Taiwan University Hospital. Results: Seven (77.8%) patients were more than 50 years old. Five (55.6%) had diabetes, and three (33.3%) had hematologic diseases. All cases were associated with paranasal sinusitis. The most frequent initial symptom was headache (66.7%), followed by ophthalmic complaints (diplopia or ophthalmoplegia, 55.6%; blurred vision or blindness, 55.6%), and ptosis (44.4%). Initial cranial images failed to identify CTS in all patients. Subsequent magnetic resonance imaging (MRI) or coronal contrast-enhanced CT (CECT) with thin section confirmed the diagnosis. Fungi were the most common pathogens (55.6%). The inhospital case-fatality rate was high (44.4%). Conclusion: Due to the high case-fatality rate and low yield rate of blood cultures, fungal CST should be suspected in an immunocompromised patient with ophthalmic complaints that progress from one eye to the other. Coronal thin-section CECT may be a useful alternative to MRI as a diagnostic modality for this condition.

Original languageEnglish
Pages (from-to)203-209
Number of pages7
JournalJournal of the Formosan Medical Association
Volume105
Issue number3
DOIs
Publication statusPublished - Jan 1 2006
Externally publishedYes

Fingerprint

Cavernous Sinus Thrombosis
Taiwan
Magnetic Resonance Imaging
Ophthalmoplegia
Cavernous Sinus
Diplopia
Mortality
Hematologic Diseases
Sinusitis
Immunocompromised Host
Blindness
Rare Diseases
Neuroimaging
Headache
Fungi
Tomography
Infection

Keywords

  • Cavernous sinus thrombosis
  • Diabetes
  • Sinusitis
  • Zygomycosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Septic cavernous sinus thrombosis : An unusual and fatal disease. / Chen, Huan Wen; Su, Chan Ping; Su, Deng Huang; Chen, Huan Wu; Chen, Yee Chun.

In: Journal of the Formosan Medical Association, Vol. 105, No. 3, 01.01.2006, p. 203-209.

Research output: Contribution to journalArticle

Chen, Huan Wen ; Su, Chan Ping ; Su, Deng Huang ; Chen, Huan Wu ; Chen, Yee Chun. / Septic cavernous sinus thrombosis : An unusual and fatal disease. In: Journal of the Formosan Medical Association. 2006 ; Vol. 105, No. 3. pp. 203-209.
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abstract = "Background: Septic cavernous sinus thrombosis (CST) is a rare and fatal disease. Clinical presentations in the early stage are nonspecific, and the sensitivity of cranial axial computed tomography (CT) with thick section is low. This study analyzed the clinical manifestation and neuroimaging findings in patients with septic CST in a medical center in Taiwan. Methods: This retrospective case series included nine patients with septic CST who had typical symptoms and clinical course, evidence of infection, and imaging studies which demonstrated cavernous sinus lesion, and who were treated between 1995 and 2003 at National Taiwan University Hospital. Results: Seven (77.8{\%}) patients were more than 50 years old. Five (55.6{\%}) had diabetes, and three (33.3{\%}) had hematologic diseases. All cases were associated with paranasal sinusitis. The most frequent initial symptom was headache (66.7{\%}), followed by ophthalmic complaints (diplopia or ophthalmoplegia, 55.6{\%}; blurred vision or blindness, 55.6{\%}), and ptosis (44.4{\%}). Initial cranial images failed to identify CTS in all patients. Subsequent magnetic resonance imaging (MRI) or coronal contrast-enhanced CT (CECT) with thin section confirmed the diagnosis. Fungi were the most common pathogens (55.6{\%}). The inhospital case-fatality rate was high (44.4{\%}). Conclusion: Due to the high case-fatality rate and low yield rate of blood cultures, fungal CST should be suspected in an immunocompromised patient with ophthalmic complaints that progress from one eye to the other. Coronal thin-section CECT may be a useful alternative to MRI as a diagnostic modality for this condition.",
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