Images in Clinical Medicine
Cavernous Sinus Thrombosis
N Engl J Med 2008; 359:2266November 20, 2008
- Article
A 34-year-old woman with a 3-year history of systemic lupus erythematosus was admitted to the hospital with sore throat and headache that had lasted for 3 weeks. She had been receiving cyclophosphamide for lupus nephritis for the previous 2 years. On the eighth hospital day, she reported severe headache and bilateral pain and bruising of the eyes. A day later, proptosis developed, with severe chemosis and eyelid edema, and her pupils were bilaterally nonreactive to light on examination. A preliminary diagnosis of extensive intracranial venous thrombosis was confirmed on magnetic resonance imaging. Axial T2-weighted imaging at the level of the cavernous sinus was performed. As compared with an image from a healthy adult (Figure 1A in the Supplementary Appendix, available with the full text of this article at www.nejm.org), the patient's image showed enlargement and heterogeneity in bilateral cavernous sinuses and in the right transverse sinus, with loss of flow void (Figure 1B in the Supplementary Appendix). Bilateral exophthalmos, thickening of extraocular muscles, periorbital edema, and hyperintense signal compatible with inflammation of the bilateral mastoid cells (Figure 1B in the Supplementary Appendix) were also observed. Despite treatment with heparin for 5 days, the patient died from cardiac arrest following brain edema.
Ayaz Agayev, M.D.
Sabri Yilmaz, M.D.
Istanbul Faculty of Medicine, Istanbul, Turkey
ayazagayev@gmail.com - Citing Articles (1)
Citing Articles
1
Aristotelis Filippidis, Eftychia Kapsalaki, Gianna Patramani, Kostas N. Fountas. (2009) Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment. Neurosurgical FOCUS 27:5, E3
CrossRef
