Songu Murat, Can Nazan, Onal Kazim, Arslanoglu Secil, Erdogan Nezahat, Kopar Aylin, Ciger Ejder
Department of Otorhinolaryngology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey.
Ear Nose Throat J. 2012 Jul;91(7):E26-30.
Septic cavernous sinus thrombosis is a rare and potentially life-threatening complication of infections involving the paranasal sinuses or the middle one-third of the face. We report a challenging case of cavernous sinus thrombosis to familiarize otolaryngologists with its clinical features, diagnosis, and management. The patient was a 45-year-old diabetic woman whose signs and symptoms mimicked those of complicated fungal sinusitis. She presented with fever, nausea without vomiting, frontal headache, bilateral ptosis and swelling, double vision, a partial loss of visual acuity in the left eye, and restricted lateral ocular movements. Her Snellen visual acuity had been reduced to 8/10 on the right and 6/10 on the left. Radiologic investigation revealed cavernous sinus extension of sphenoid sinusitis and a fungus-ball appearance in the sphenoid sinus. On the second day of her admission, the patient's vision was further reduced to 6/10 on the right and 2/10 on the left. She then underwent urgent bilateral anterior and posterior ethmoidectomy and sphenoidectomy. At postoperative follow-up, her vision had stabilized at 10/10 bilaterally. At 2 months after discharge, she exhibited no evidence of abducens nerve palsy, and her ocular function had returned to normal. The diagnosis of cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging. The favorable outcome in our case was attributable to early diagnosis, prompt initiation of appropriate intravenous antibiotic therapy, and surgical drainage by the skillful surgical team.
化脓性海绵窦血栓形成是一种罕见且可能危及生命的并发症，常由鼻窦或面部中三分之一区域的感染引起。我们报告一例具有挑战性的海绵窦血栓形成病例，旨在让耳鼻喉科医生熟悉其临床特征、诊断和治疗方法。患者为一名45岁的糖尿病女性，其体征和症状与复杂性真菌性鼻窦炎相似。她出现发热、恶心但无呕吐、额部头痛、双侧上睑下垂及肿胀、复视、左眼视力部分丧失以及眼球外展受限。她的斯内伦视力在右侧降至8/10，在左侧降至6/10。影像学检查显示蝶窦炎蔓延至海绵窦，蝶窦内有真菌球样表现。入院第二天，患者视力进一步下降，右侧降至6/10，左侧降至2/10。随后她接受了紧急双侧前后筛窦切除术和蝶窦切除术。术后随访时，她的视力双侧稳定在10/10。出院2个月后，她没有展神经麻痹的迹象，眼部功能已恢复正常。海绵窦血栓形成的诊断需要高度怀疑并通过影像学检查确诊。我们病例的良好预后归因于早期诊断、及时开始适当的静脉抗生素治疗以及由技术娴熟的手术团队进行手术引流。
