Septic Cerebral Venosinus Thrombosis Secondary to an Odontogenic Infection

Hongvan Le, MD; Shane Prejean, MD; Madeleine Heck, MD

BACKGROUND 

Cerebral venosinus thrombosis (CVT) is an uncommon, potentially fatal disease that is more common in young adults and children. Thrombophilia, elevated estrogenic states, and infections are the most common risk factors in patients who develop CVT. 

CASE 

A 69-year-old man with a right-sided odontogenic infection presented with fever, headache, opthalmoplegia, and periorbital swelling. Imaging revealed evidence of meningitis and thrombosis of bilateral ophthalmic veins, the cavernous sinus, right internal jugular vein, and sigmoid sinus. The patient was treated with empiric antibiotic therapy and unfractionated heparin. He recovered with only mild impairment in right eye abduction. 

DISCUSSION 

Early diagnosis and prompt treatment of CVT is vital in reducing the associated morbidity and mortality. Unfractionated or low molecular weight heparin may be safely used in CVT patients. Thrombolytic therapy is an option in clinically severe cases. Treatment also includes addressing the underlying cause and management of early complications.

 

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