Chronic Sphenoid Sinusitis-associated Cavernous Sinus Thrombophlebitis Complicated with Internal Carotid Artery Thrombosis and Multiple Cerebral Infarction: a Case Report and Literature Review

doi:10.12114/j.issn.1007-9572.2022.0462

Abstract

Abstract:

Cavernous sinus thrombophlebitis (CST) is a rare disease that may be life-threatening. The overall morbidity and mortality of CST are still high although the introduction of antibiotics has greatly promoted the reduction of them, which mostly due to delayed treatment caused by misdiagnosis. CST with internal carotid artery thrombosis and multiple cerebral infarction secondary to chronic sphenoid sinusitis is rare, but it is essential to rapidly identify, diagnose and treat the disease, since it can lead to serious neurological sequelae. We encountered a patient with chronic sphenoid sinusitis-associated internal carotid artery thrombosis and multiple cerebral infarction, identified his vascular lesions using high-resolution magnetic resonance imaging, and discussed relevant diagnosis and treatment for him, his prognosis as well as the pathogenesis based on a literature review, hoping to inform clinical treatment of CST patients.

Key words: Thrombophlebitis, Cavernous sinus thrombophlebitis, Sphenoid sinusitis, Carotid artery thrombosis, Brain infarction, Diabetes mellitus, Magnetic resonance imaging, Case report

摘要：

海绵窦血栓性静脉炎（CST）是一种罕见且可能危及生命的疾病。随着抗生素的使用，CST的死亡率已明显下降，尽管目前CST的死亡率有所改善但仍然较高，多数由误诊引起的延误治疗所致。慢性蝶窦炎致CST伴颈内动脉血栓形成和多发脑梗死的病例报告较少见，但伴有颈内动脉血栓形成的CST可导致严重的神经系统后遗症，因此有必要迅速识别、诊断和治疗该疾病。本文报道了1例慢性蝶窦炎致CST伴颈内动脉血栓形成和多发脑梗死，并应用高分辨率磁共振成像明确有血管病变患者的诊治过程，结合文献回顾性分析CST伴颈内动脉受累的诊治及预后，并探讨其发病机制，希望为CST患者的临床治疗提供更多资料及经验。

关键词: 血栓性静脉炎, 海绵窦血栓性静脉炎, 蝶窦炎, 颈动脉血栓形成, 脑梗死, 糖尿病, 磁共振成像, 病例报告

Lipeng DONG,Jinming CHENG,Bao CHU, et al. Chronic Sphenoid Sinusitis-associated Cavernous Sinus Thrombophlebitis Complicated with Internal Carotid Artery Thrombosis and Multiple Cerebral Infarction: a Case Report and Literature Review[J]. Chinese General Practice, 2022, 25(27): 3452-3458. DOI: 10.12114/j.issn.1007-9572.2022.0462.
董立朋,程金明,楚宝等. 慢性蝶窦炎致海绵窦血栓性静脉炎伴颈内动脉血栓形成和多发脑梗死一例报道并文献复习[J]. 中国全科医学, 2022, 25(27): 3452-3458. DOI: 10.12114/j.issn.1007-9572.2022.0462.

Figures/Tables 6

Figure 1 Nasopharyngoscopy showing sinusitis and nasal polyps

Figure 2 Findings of cranial CT and CTA performed on August 8，2019

Figure 3 Findings of enhanced cranial MRI performed on August 8，2019

Figure 4 Findings of diffusion-weighted cranial MRI performed on August 20，2019

Figure 5 Cranial high-resolution MRI measuring apparent diffusion coefficient and findings of magnetic resonance angiography performed on August 20，2019

Figure 6 Findings of cranial high-resolution MRI performed on August 20，2019

References 33

[1]	LIZÉ F，VERILLAUD B，VIRONNEAU P，et al. Septic cavernous sinus thrombosis secondary to acute bacterial sinusitis：a retrospective study of seven cases[J]. Am J Rhinol Allergy，2015，29（1）：e7-12. DOI：10.2500/ajra.2015.29.4127.
[2]	DESA V，GREEN R. Cavernous sinus thrombosis：current therapy[J]. J Oral Maxillofac Surg，2012，70（9）：2085-2091. DOI：10.1016/j.joms.2011.09.048
[3]	YARINGTON C T Jr. The prognosis and treatment of cavernous sinus thrombosis. Review of 878 cases in the literature[J]. Ann Otol Rhinol Laryngol，1961，70：263-267. DOI：10.1177/000348946107000122.
[4]	EBRIGHT J R，PACE M T，NIAZI A F. Septic thrombosis of the cavernous sinuses[J]. Arch Intern Med，2001，161（22）：2671-2676. DOI：10.1001/archinte.161.22.2671.
[5]	BRANSON S V，MCCLINTIC E，YEATTS R P. Septic cavernous sinus thrombosis associated with orbital cellulitis：a report of 6 cases and review of literature[J]. Ophthalmic Plast Reconstr Surg，2019，35（3）：272-280. DOI：10.1097/IOP.0000000000001231.
[6]	CARANFA J T，YOON M K. Septic cavernous sinus thrombosis：a review[J]. Surv Ophthalmol，2021，66（6）：1021-1030. DOI：10.1016/j.survophthal.2021.03.009.
[7]	AGHA A，PANGY T，AJAYI O，et al. Septic cavernous sinus thrombosis；a rare cause of unilateral exophthalmos[J]. Ulster Med J，2020，89（2）：131-132.
[8]	SUNTRUP S，KEMMLING A，DZIEWAS R，et al. Septic cavernous sinus thrombosis complicated by occlusion of the internal carotid artery and multiple embolic strokes after surgery of an anorectal abscess：a clinical chameleon[J]. Neurologist，2012，18（5）：310-312. DOI：10.1097/NRL.0b013e31826752a6.
[9]	KIM J M，KANG K W，KIM H，et al. Septic cavernous sinus thrombosis after minor head trauma：a case report[J]. Medicine （Baltimore），2022，101（10）：e29057. DOI：10.1097/MD.0000000000029057.
[10]	LEW D，SOUTHWICK F S，MONTGOMERY W W，et al. Sphenoid sinusitis. A review of 30 cases[J]. N Engl J Med，1983，309（19）：1149-1154. DOI：10.1056/NEJM198311103091904.
[11]	BLACK P M，ZERVAS N T，CANDIA G L. Incidence and management of complications of transsphenoidal operation for pituitary adenomas[J]. Neurosurgery，1987，20（6）：920-924. DOI：10.1227/00006123-198706000-00017.
[12]	SCHUKNECHT B，SIMMEN D，YÜKSEL C，et al. Tributary venosinus occlusion and septic cavernous sinus thrombosis：CT and MR findings[J]. AJNR Am J Neuroradiol，1998，19（4）：617-626.
[13]	BHATIA H，KAUR R，BEDI R. MR imaging of cavernous sinus thrombosis[J]. Eur J Radiol Open，2020，7：100226. DOI：10.1016/j.ejro.2020.100226.
[14]	PRESS C A，LINDSAY A，STENCE N V，et al. Cavernous sinus thrombosis in children：imaging characteristics and clinical outcomes[J]. Stroke，2015，46（9）：2657-2660. DOI：10.1161/STROKEAHA.115.009437.
[15]	VAN DER POEL N A，MOURITS M P，DE WIN M M L，et al. Prognosis of septic cavernous sinus thrombosis remarkably improved：a case series of 12 patients and literature review[J]. Eur Arch Otorhinolaryngol，2018，275（9）：2387-2395. DOI：10.1007/s00405-018-5062-9.
[16]	BHATIA K，JONES N S. Septic cavernous sinus thrombosis secondary to sinusitis：are anticoagulants indicated? A review of the literature[J]. J Laryngol Otol，2002，116（9）：667-676. DOI：10.1258/002221502760237920.
[17]	BERGE J，LOUAIL C，CAILLÉ J M. Cavernous sinus thrombosis diagnostic approach[J]. J Neuroradiol，1994，21（2）：101-117.
[18]	CHEN B A，LIU Z H，CHUANG C C，et al. Different causes and diverse outcomes of extremely rare septic cavernous sinus thrombosis complicated with internal carotid artery Stenosis[J]. Eur J Med Res，2021，26（1）：120. DOI：10.1186/s40001-021-00588-6.
[19]	KOJAN S，AL-JUMAH M. Infection related cerebral venous thrombosis[J]. J Pak Med Assoc，2006，56（11）：494-497.
[20]	CHEN H W，SU C P，SU D H，et al. Septic cavernous sinus thrombosis：an unusual and fatal disease[J]. Taiwan Yi Zhi，2006，105（3）：203-209. DOI：10.1016/S0929-6646(09)60306-5.
[21]	MARTEL A. Septic thrombosis of cavernous sinus extended to the ipsilateral internal jugular vein and transversal sinus with favorable outcome：clinical and radiological features of a Lemierre syndrome[J]. Orbit，2018，37（2）：94-96. DOI：10.1080/01676830.2017.1383458.
[22]	HOSHINO C，SATOH N，SUGAWARA S，et al. Septic cavernous sinus thrombosis complicated by narrowing of the internal carotid artery，subarachnoid abscess and multiple pulmonary septic emboli[J]. Intern Med，2007，46（6）：317-323. DOI：10.2169/internalmedicine.46.6202.
[23]	ANGUIZOLA-TAMAYO D A，BALLVÉ-MARTÍN A，CAMPOS-FERNÁNDEZ D，et al. Cavernous sinus syndrome secondary to thrombophlebitis due to Streptococcus intermedius complicated with vasculitis of the internal carotid artery and brain abscesses[J]. Rev Neurol，2020，70（1）：19-22. DOI：10.33588/rn.7001.2019376.
[24]	WHITEHEAD E，DE SOUZA F M. Acute sphenoid sinusitis causing spasm of the internal carotid artery[J]. Can J Otolaryngol，1974，3（2）：216-218.
[25]	CHEN J S，MUKHERJEE P，DILLON W P，et al. Restricted diffusion in bilateral optic nerves and retinas as an indicator of venous ischemia caused by cavernous sinus thrombophlebitis[J]. AJNR Am J Neuroradiol，2006，27（9）：1815-1816.
[26]	KHATRI I A，WASAY M. Septic cerebral venous sinus thrombosis[J]. J Neurol Sci，2016，362：221-227. DOI：10.1016/j.jns.2016.01.035.
[27]	SHAW R E. Cavernous sinus thrombophlebitis：a review[J]. Br J Surg，1952，40（159）：40-48. DOI：10.1002/bjs.18004015908.
[28]	WANG Y H，CHEN P Y，TING P J，et al. A review of eight cases of cavernous sinus thrombosis secondary to sphenoid sinusitis，including a12-year-old girl at the present department[J]. Infect Dis （Lond），2017，49（9）：641-646. DOI：10.1080/23744235.2017.1331465.
[29]	WEERASINGHE D，LUECK C J. Septic cavernous sinus thrombosis：case report and review of the literature[J]. Neuroophthalmology，2016，40（6）：263-276. DOI：10.1080/01658107.2016.1230138.
[30]	EINHÄUPL K，STAM J，BOUSSER M G，et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients[J]. Eur J Neurol，2010，17（10）：1229-1235. DOI：10.1111/j.1468-1331.2010.03011.x.
[31]	LEE H R，KIM H W，PARK J H，et al. Septic cavernous sinus thrombosis with infectious arteritis of the internal carotid artery[J]. BMJ Case Rep，2015，2015：bcr2015213314. DOI：10.1136/bcr-2015-213314.
[32]	MADHUSUDHAN K S，KANDPAL H，AHUJA J. Cavernous sinus thrombophlebitis causing reversible narrowing of internal carotid artery[J]. Neurol India，2009，57（1）：102-103. DOI：10.4103/0028-3886.48792.
[33]	JOSEPH K T，MOMJIAN-MAYOR I，VARGAS M I，et al. Bilateral internal carotid artery Stenosis complicating acute sinusitis[J]. Pract Neurol，2013，13（6）：377-379. DOI：10.1136/practneurol-2012-000383.