Cavernous sinus thrombosis
One month of increasing headaches, left proptosis added 7 days ago
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Left eye proptosis is the first symptom, which must be seen by any radiologist.
Vivid orbital and periorbital swelling.
Enlargement of the left cavernous sinus seen on pre-contrast T1 coronals.
Post-contrast scans reflects absent blood flow in the left superior ophthalmic vein due to its thrombosis; dural thickening within left cavernous sinus caused by inflammation.
DWI shows a small acute infarction at the right flocculus.
Sphenoid paranasal sinus mucosa hypertrophy probably being cause of infection with thrombosis development.
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This patient already has complete brain MRI month ago, when headaches started, with findings of old lacunar infarcts only. Now we see typical findings of cavernous sinus trombosis (CST). It most commonly results from contiguous spread of infection from a nasal furuncle (50%), sphenoidal or ethmoidal sinuses (30%) and dental infections (10%). We guess spenoiditis +/- caries were reasons for this dangerous complication. It has a mortality rate of less than 20% if treated with antibiotics. Before antibiotics were available, the mortality was 80–100%. Morbidity rates also dropped from 70% to 22% due to earlier diagnosis and treatment.