[Case of aseptic primary cavernous sinus thrombosis].

Cavernous sinus thrombosis (CST) is classified into aseptic and septic types on the basis of its pathognosis. Aspetic CST includes the primary and secondary types, in which the former is an unknown etiology. We have recently experienced a rare case of aseptic primary CST which showed initially the intraorbital congestive symptoms. This 64 years male admitted to our clinic with the complaints of non-pulsatile exophthalmosis and conjunctival congestion of left eye. On admission, he showed mild external ophthalmoplegia and clinical evidence of intraorbital congestion (choked disc, retinal vein thrombosis, retinal hemorrhage) on the left side. The blood examination, including the thyroid studies, revealed no abnormal findings except for mild anemia and increased ESR. In carotid angiography, there was occlusion of Sylvian vein and cavernous sinus in the affected side. Orbital venography and retrograde jugular venography demonstrated the occlusion of superior ophthalmic vein, cavernous sinus and inferior petreous sinus in left side. CT scan revealed parasellar enhanced area in the normal pattern. Enhanced orbital CT scan revealed the hypertrophy of left external occular muscles and optic nerve with a tomogram of the dilatated superior ophthalmic vein. Aseptic primary CST was diagnosed on the basis of clinical course, cavernous sinography and CT findings.