The clinical characteristics, implicated pathogens and therapeutic outcomes of culture-proven septic cavernous sinus thrombosis. (October 2019)

• Record Type: Journal Article
• Authors: Hsu, Che-Wei; Tsai, Wan-Chen; Lien, Chia-Yi; Lee, Jun-Jun; Chang, Wen-Neng
• Is Part Of: Journal of clinical neuroscience. Volume 68(2019)
• Page Start: 111
• Page End: 116
• Publication Date: 2019-10
• Subjects: Cavernous sinus thrombosis -- Septic -- Adult -- Sinusitis -- Diabetes mellitus -- Onset-to-diagnosis -- MRI; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.07.022
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Septic cavernous sinus thrombosis (CTS) is a rare infection in modern antibiotic era. MRI based culture-proven septic CTS in the adults has not been examined solely. The clinical and MRI data of 14 culture-proven septic CST adults were analyzed. Staphylococcal and Aspergillus spp. were the most commonly implicated pathogen. 7% of the patients died in the hospital and 67% (8/12) of the survivors had neurological deficits. Abstract: In this magnetic resonance imaging-based study, we investigated the clinical features, neuroimaging features and therapeutic outcomes of 14 adults (eight men and six women; mean age 60.4 years; range 37–77 years) with septic cavernous sinus thrombosis (CST). Of the underlying conditions, 10 had diabetes mellitus and 13 had concomitant sphenoid sinusitis. Headache (n = 13) and ophthalmoplegia (n = 13) were the most common clinical presentations, followed by fever (n = 9) and other neuro-vascular signs and symptoms. The duration from the onset of symptoms to diagnosis ranged from 1 to 61 days, and more than 64% (9/14) of the septic CST patients were diagnosed >7 days after symptom onset. Expansion of the cavernous sinus was the most common neuroimaging feature, followed by convexity of the lateral wall of the cavernous sinus (5) and filling defect of the cavernous sinus (4). Staphylococcal species (spp.) was the most commonly implicated pathogen, followed by Aspergillus spp. Despite treatment, 7% (1/14) of the patients died in the hospital and 67% (8/12) of the survivors had neurological deficits. The duration of onset-to-diagnosis and the presence of hemiparesis were significant prognostic factors. These results provide a preliminary view of this uncommon infectious syndrome. Further large-scale studies are needed to better delineate septic CST in adults.