Dolapsakis Christodoulos, Kranidioti Eleftheria, Katsila Sofia, Samarkos Michael
3rd Department of Medicine, Evaggelismos General Hospital, Athens, Greece.
1st Department of Medicine, Laikon Hospital, Athens, Greece.
BMJ Case Rep. 2019 Jan 29;12(1):e227302. doi: 10.1136/bcr-2018-227302.
We report a case of septic thrombosis of the right cavernous sinus in a diabetic woman in her late 70's due to ipsilateral sphenoid sinusitis. The diagnosis was delayed and made only after the abrupt and dramatic appearance of the manifestations of sinus thrombosis. The patient developed, among the other symptoms, right peripheral facial palsy, which is a very rare manifestation in cavernous sinus thrombosis (CST). She was treated with broad-spectrum antibiotics and enoxaparin. The day of the scheduled drainage of sphenoid sinus-24 hours after the initiation of anticoagulation-she developed fatal subarachnoid haemorrhage. Our case demonstrates the difficulty of timely diagnosis of acute sphenoid sinusitis which has emerged as the most common primary infectious source potentially leading in CST. It also underscores the uncertainty concerning the use of anticoagulation in cerebral sinus thrombosis of infectious origin.
我们报告一例70多岁晚期糖尿病女性因同侧蝶窦炎导致右侧海绵窦感染性血栓形成的病例。诊断被延误，直到窦血栓形成的症状突然且显著出现后才得以确诊。该患者除其他症状外，还出现了右侧周围性面瘫，这在海绵窦血栓形成（CST）中是非常罕见的表现。她接受了广谱抗生素和依诺肝素治疗。在开始抗凝治疗24小时后，即预定进行蝶窦引流的当天，她发生了致命的蛛网膜下腔出血。我们的病例表明，及时诊断急性蝶窦炎存在困难，而急性蝶窦炎已成为可能导致CST的最常见原发性感染源。它还凸显了在感染性脑窦血栓形成中使用抗凝治疗的不确定性。
