Eweiss A, Mukonoweshuro W, Khalil H S
Department of Otolaryngology, Derriford Hospital, Plymouth, UK.
J Laryngol Otol. 2010 Aug;124(8):928-30. doi: 10.1017/S0022215110000113. Epub 2010 Mar 5.
To report what we believe to be the first case in the English language literature of unilateral cavernous sinus thrombosis complicating contralateral sphenoid sinusitis.
A 62-year-old man presented to his general practitioner with a severe, right-sided, temporal headache. He was diagnosed with temporal arteritis and treated with systemic steroids. After five days, he developed right proptosis, ophthalmoplegia and ptosis. He was referred to the neurologists. After an urgent computed tomography head scan and computed tomography angiogram, a diagnosis of carotido-cavernous fistula was made. However, this was subsequently excluded after a negative cerebral angiogram. A review of the scans enabled diagnosis of right cavernous sinus thrombosis secondary to left sphenoiditis. The patient was referred to the otolaryngology team. After an urgent endoscopic sphenoidotomy and medical treatment, all symptoms and signs improved dramatically.
Sphenoiditis can lead to contralateral cavernous sinus thrombosis. Urgent surgical sphenoidotomy, with appropriate medical treatment, can be successful in this life-threatening complication.
报告我们认为英文文献中首例单侧海绵窦血栓形成并发对侧蝶窦炎的病例。
一名62岁男性因严重的右侧颞部头痛就诊于全科医生。他被诊断为颞动脉炎并接受全身类固醇治疗。五天后，他出现右侧眼球突出、眼肌麻痹和上睑下垂。他被转诊至神经科医生处。经紧急头颅计算机断层扫描（CT）和CT血管造影后，诊断为颈内动脉海绵窦瘘。然而，随后脑血管造影结果为阴性，排除了该诊断。复查扫描后诊断为继发于左侧蝶窦炎的右侧海绵窦血栓形成。患者被转诊至耳鼻喉科团队。经紧急内镜下蝶窦切开术及药物治疗后，所有症状和体征均显著改善。
蝶窦炎可导致对侧海绵窦血栓形成。紧急手术行蝶窦切开术并配合适当的药物治疗，可成功治疗这种危及生命的并发症。
