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Cavernous sinus thrombosis secondary to contralateral sphenoid sinusitis: a diagnostic challenge

Published online by Cambridge University Press:  05 March 2010

A Eweiss ,
W Mukonoweshuro  and
H S Khalil
A Eweiss
Affiliation:
Department of Otolaryngology, Derriford Hospital, Plymouth, UK
W Mukonoweshuro
Affiliation:
Department of Radiology, Derriford Hospital, Plymouth, UK
H S Khalil*
Affiliation:
Department of Otolaryngology, Derriford Hospital, Plymouth, UK
*
Address for correspondence: Mr Hisham S Khalil, Consultant ENT Surgeon and Clinical Sub-Dean, Derriford Hospital and Peninsula College of Medicine and Dentistry, Plymouth PL6 5HU, UK. E-mail: hisham.khalil@phnt.swest.nhs.uk
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Abstract

Objective:

To report what we believe to be the first case in the English language literature of unilateral cavernous sinus thrombosis complicating contralateral sphenoid sinusitis.

Case report:

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.

Conclusions:

Sphenoiditis can lead to contralateral cavernous sinus thrombosis. Urgent surgical sphenoidotomy, with appropriate medical treatment, can be successful in this life-threatening complication.

Keywords

Cavernous SinusSphenoid SinusitisIntracranial ComplicationsProptosisOphthalmoplegia
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 8 , August 2010 , pp. 928 - 930
Copyright
Copyright © JLO (1984) Limited 2010

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Footnotes

Presented at the British Rhinological Society Meeting, 15 May 2009, Cheltenham.

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