Korean J Cerebrovasc Surg.  2010 Sep;12(3):131-135.

Cavernous Sinus Thrombophlebitis: Case Report and Literature Review

• Lee MH
• Lee YS
• Lee JH
• Ryu KY
• Kang DG

Abstract

Cavernous sinus thrombophlebitis is characterized by edema of the eyelids and the conjunctivae, and paralysis of the cranial nerves. It is rare, often misdiagnosed or underestimated by neurosurgeons, and is generally related with high rates of mortality and morbidity. High rate of suspicion is required for early diagnosis, and aggressive managements can lead to better outcomes. With recent advancements in antibiotic therapies, the mortality rate has been decreased to less than 30%. However, the morbidity remains high and complete recovery is rare. A 69-year-old woman presented with headache and right ocular pain with sixth cranial nerve palsy for one week. Under the suspicion of Tolosa-Hunt syndrome, steroid treatment was done. On discharge, there was improvement in right ocular pain, but the cranial nerve palsy remained. Subsequently, the patient returned with left ocular pain, lid swelling, redness, ecchymosis of conjunctiva, and ptosis. Enhanced brain magnetic resonance imaging revealed an asymmetrically enlarged left cavernous sinus with heterogeneously enhancing contour. Intravenous antibiotics and oral steroids along with anticoagulant medications were administered.

Keyword

Cavernous sinus; Cavernous sinus thrombophlebitis; Cavernous sinus thrombosis; Exophthalmos

MeSH Terms

Abducens Nerve Diseases
Aged
Anti-Bacterial Agents
Brain
Cavernous Sinus
Cavernous Sinus Thrombosis
Caves
Conjunctiva
Cranial Nerve Diseases
Cranial Nerves
Early Diagnosis
Ecchymosis
Edema
Exophthalmos
Eyelids
Female
Headache
Humans
Magnetic Resonance Imaging
Paralysis
Steroids
Tolosa-Hunt Syndrome
Anti-Bacterial Agents
Steroids