Septic cavernous sinus thrombosis

Abstract

Although septic cavernous sinus thrombosis represents a rare cerebral vascular event, the morbidity and mortality can be profound. Diagnosis of this disease remains challenging, despite recent advances in imaging technology. We present a 71-year-old man who presented with symptoms of retro-orbital pain, swelling and a recent history of being treated for bacterial sinusitis. An initial non-contrast head computed tomography showed a dilated, hyperdense appearance of his left superior ophthalmic vein, with subsequent magnetic resonance imaging suggestive of bilateral ophthalmic vein thrombosis likely from cavernous sinus origin. The patient had blood cultures positive for Streptococcus anginosus, and was successfully treated with several weeks of i.v. antibiotics and anticoagulation.