Department of Neurosurgery, Mianyang Central Hospital Affiliated to University of Electronic Science and Technology of China, Mianyang, China.
Department of Rehabilitation Therapy, Mianyang Central Hospital Affiliated to University of Electronic Science and Technology of China, Mianyang, China.
Medicine (Baltimore). 2023 Nov 24;102(47):e36123. doi: 10.1097/MD.0000000000036123.
Septic cavernous sinus thrombosis (SCST) is a rare infectious thrombophlebitic disease. The infection often arises from the tissues surrounding the cavernous sinus as well as the cavernous sinus drainage. Early symptoms of SCST include fever, headache, proptosis, ptosis, bulbar conjunctival edema, and limited eye movement. The complications include venous sinus thrombosis, intracerebral abscess, and subdural empyema. Aneurysmal subarachnoid hemorrhage combined with acute cerebral infarction has not been reported.
A 46-year-old man presented with visual impairment in his right eye and intermittent headache for 2 months. Ten days later, the patient developed a sudden loss of consciousness, coma, cardiac arrest, and respiratory arrest. The patient eventually died.
SCST, acute cerebral infarction, aneurysmal subarachnoid hemorrhage, anterior cerebral artery aneurysm.
Antiplatelet and lipid-lowering therapy, antibiotic treatment, emergency aneurysm clipping, and decompressive craniectomy.
The patient underwent emergency aneurysm clipping and decompressive craniectomy, and postoperative head computed tomography showed a massive cerebral infarction in the right cerebral hemisphere. The patient eventually died.
We report a case of SCST mainly presenting as acute cerebral infarction and aneurysmal subarachnoid hemorrhage, with an acute onset and ultimately a poor prognosis. This complication is extremely rare and have not yet reported according existing literatures but can be life-threatening if not recognized and treated promptly. Early antibiotic administration and early sinus drainage may alter the patient's prognosis. By describing this unusual the case we hope to raise awareness of the need of early illness detection and treatment in order to avoid catastrophic consequences. It also exemplifies the mechanism of acute inflammatory disorders and aneurysm development.
海绵窦血栓性静脉炎（SCST）是一种罕见的感染性血栓性静脉炎疾病。感染通常来自海绵窦周围的组织以及海绵窦引流区。SCST 的早期症状包括发热、头痛、眼球突出、上睑下垂、球结膜水肿和眼球运动受限。并发症包括静脉窦血栓形成、脑脓肿和硬脑膜下积脓。尚未有报道称颅内动脉瘤性蛛网膜下腔出血合并急性脑梗死。
一名 46 岁男性因右眼视力障碍和间歇性头痛就诊，病史 2 个月。10 天后，患者突发意识丧失、昏迷、心跳骤停和呼吸停止，最终死亡。
SCST、急性脑梗死、颅内动脉瘤性蛛网膜下腔出血、大脑前动脉动脉瘤。
抗血小板和降脂治疗、抗生素治疗、紧急动脉瘤夹闭术和去骨瓣减压术。
患者接受了紧急动脉瘤夹闭术和去骨瓣减压术，术后头部 CT 显示右侧大脑半球大面积脑梗死。患者最终死亡。
我们报告了 1 例主要表现为急性脑梗死和颅内动脉瘤性蛛网膜下腔出血的 SCST 病例，起病急，预后差。这种并发症非常罕见，目前尚无文献报道，但如果不能及时识别和治疗，可能危及生命。早期使用抗生素和早期窦道引流可能会改变患者的预后。通过描述这一不常见病例，我们希望提高对早期疾病检测和治疗的认识，以避免灾难性后果。这也例示了急性炎症性疾病和动脉瘤发展的机制。
