Cavernous Sinus Thrombosis Secondary to Sphenoid Sinus Fungal Ball

Abstract Background Isolated sphenoid sinus disease (ISSD) is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurologic, and vascular structures nearby. Case report We present a case of a 60-year-old female with a history of severe left-sided headache, facial pain, diplopia, and left lateral rectus palsy. She was initially referred to ophthalmology and rheumatology for possible giant cell arteritis. MRI scans revealed opacification in left sphenoid sinus consistent with left sphenoid sinusitis. There were no signs of cavernous sinus thrombosis. She was then referred to ENT and underwent endoscopic transnasal sphenoidotomy procedure. Culture results showed Haemophilus Influenza and fungal pseudohyphae. Her palsy and headaches recovered completely 3 months later with a course of antibiotics and antifungals. Literature review for lateral rectus palsy secondary to sphenoid sinusitis without cavernous sinus thrombosis showed it is not a common condition and this case report should serve as a reminder to consider paranasal sinus disease when assessing these patients. Conclusions The onset of ISSD is often insidious and diagnosis of this condition remains a challenge. MRI and CT imaging remain the gold standard for recognising and managing this condition.

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Cavernous sinus thrombosis as a serious complication of sphenoid sinusitis in children

10.5327/1516-3180.232 ◽

2021 ◽

Author(s):

Lícia Apoline Santos Marques ◽

Iago Antunes Macedo de Souza ◽

Luís Gustavo Miranda Cavalcante Farias ◽

Ellem Silva Pestana ◽

Paula Sabrina Martins Gomes da Rocha ◽

...

Keyword(s):

Cavernous Sinus ◽

Paranasal Sinuses ◽

Sphenoid Sinus ◽

Sinus Thrombosis ◽

Sella Turcica ◽

Primary Source ◽

Cavernous Sinus Thrombosis ◽

Sphenoid Sinusitis ◽

The Face ◽

Septic Thrombosis

Introduction:The cavernous sinus is a venous plexus delimited by the dura mater and sited at the base of skull, laterally to the sella turcica and to the sphenoid sinus. The cavernous sinus thrombosis (CST) is a serious illness that may result from infection of any tissue drained by the cavernous sinus (septic thrombosis). Septic thrombosis (ST) may occur through the suppurative process by the level of the orbit, of the upper half of the face or paranasal sinuses , constituting a critical complication of sinusitis. Objectives: To verify the association between cavernous sinus thrombosis and sphenoid sinusitis in children, in the bibliographic productions of the last 10 years. Methods:This is an integrative literature review, with a search carried out in the database of the Medical Literature and Retrieval System onLine (MEDLINE), using a combination of the following Health Sciences Descriptors (DECS): “Sphenoid Sinusitis” and “Thrombosis” And “ Cavernous sinus” in “ Children ”. Incomplete studies were excluded from the research, carried out before 2012, totaling 7 bibliographic studies for detailed analysis. Results:CST can result from infection of any tissue drained from the cavernous sinus. This includes the face, tonsils, soft palate, teeth and ears.Only 15% of cases of CST in patients up to 12 years of age, originated from the paranasal sinuses. However, more recent studies advance that sinusitis is currently the most common etiology. When the sinuses are the cause of CST, the sphenoid sinus emerged as the most common primary source of infection predisposing to CST, since it has important anatomical relationships with the cavernous sinus. Streptococcus has been reported as the most common organism associated with sphenoid sinusitis. Conclusion:Although CTS is a rare clinical condition, acute and persistent sphenoid sinusitis can progress to such a condition, despite medical treatment. The main support of treatment includes early diagnosis, aggressive intravenous antibiotics and appropriate surgical treatment.

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Carotid-cavernous sinus thrombosis caused by Aspergillus fumigatus

Journal of Neurosurgery ◽

10.3171/jns.1980.52.1.0120 ◽

1980 ◽

Vol 52 (1) ◽

pp. 120-125 ◽

Cited By ~ 54

Author(s):

Laligam N. Sekhar ◽

Manuel Dujovny ◽

Gutti R. Rao

Keyword(s):

Aspergillus Fumigatus ◽

Cavernous Sinus ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Sinus Thrombosis ◽

Sella Turcica ◽

Cavernous Sinus Thrombosis ◽

Content Type ◽

The Central Nervous System ◽

Fine Print

✓ A case is presented of Aspergillus fumigatus granuloma involving the sphenoid sinus, sella turcica, cavernous sinus, and the internal carotid artery. The diagnosis was established by a transsphenoidal biopsy. The infection proved difficult to treat and finally remitted after chemotherapy with a combination of amphotericin B, rifampin (rifampicin), and flucytosine (5-fluorocytosine). The spectrum of aspergillosis of the central nervous system is reviewed, and difficulties in treating this infection are considered.

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