CAVERNOUS SINUS THROMBOSIS

Rince Liyanti, Havriza Vitresia, Getry Sukmawati

Infection Imunology Sub Division, Department of
Ophthalmology Medical Faculty of Andalas University,
Dr. M. Djamil Hospital Padang, West Sumatra, Indonesia

INTRODUCTION : Cavernous sinus thrombosis (CST) is rare
and life threatening case. Acquired and inherited coagulation
abnormalities, medications, neurosurgical procedures,
infections (of midface, sinonasal area, orbits, tonsils, and
teeth), bacteremia and trauma can damage the cavernous
sinus and cause CST. Clinical signs include the orbital
symptoms (decrease of visual acuity, chemosis, protution,
etc) and cranial symptoms (unconcious, opthalmoplegy).
Diagnosis of this disease remains challenging, despite recent
advances in imaging technology. The management of CST
include of agressive antibiotic without waiting for the cultur
and sensitivity test, surgery based on indication of source of
infection, while corticosteroid and anticoagulant still
controversial.
METHOD : A CST case of 15 years old patient, consult
from neurosurgery departement with history of traffic
accident, patient was unconscious, from the brain and
orbital CT scan, we known that patient had the
intracranial and epidural haemorrhage and also
hematosinus dextra et sinistra. 2 days after that, we
found some orbital sign like chemosis, exposure keratitis,
and protusion on both eyes. Based on that history, we
diagnosed patient as CST, and managed by combined
antibiotic meropenem and vancomycin, corticosteroid,
topical antibiotic, and profilac anti glaucoma. Two days
later, patient’s had improvement, the visual acuity was
light perception in the right eye and hand movement in
the left eye, so we continue the therapy for 6 weeks

Oct 26th, 2016

Oct 22nd, 2016 Nov 18th, 2016

CONCLUSION : Cavernous sinus

thrombosis is condition that have
fatal effect. Medicamentosa is basic
treatment for CST. Agressive and
immediately therapy have good
prognosis for patient.

Brain and orbital CT Scan Fundus Photo .

KEYWORDS: cavernous
RESULT : There was improvement in visual acuity after an ultrabroad spectrum antibiotic sinus thrombosis,
combined with corticosteroid, VOD 5/20 , VOS 5/30 with corneal cicatrix. But, the visual acuity chorioretinitis,
in left eye was not excellent because of chorioretinitis toxoplasmosis that was recently known. ophthalmoplegy
REFERENCES :
.
1. Imtiaz A. Chaudhry, Waleed Al-Rashed, Osama Al-Sheikh YOA. Diagnosis and Management of Orbita Cellulitis. Common Eye Infection. 2013;123–43; 2. Mallika, Sujatha,
Narayan S, Sinumol. Orbita and Preseptal Cellulitis. Kerala Journal Ophthalmology. 2011;XXIII:10–4; 3. Ebright JR, Pace MT, Niazi AF, John R. Ebright, Mitchell T. Pace AFN, Ebright
JR, Pace MT, et al. Septic Thrombosis Of The Cavernous Sinuses. Arch Intern Medical. 2001;161:2671–6; 4. Cantor LB, Rapuano CJ, George A. Cioffi. Orbita Inflammatory And
Infectious Disorders. In: Orbit, Eyelids, and Lacrimal System. San Fransisco: American Academy of Ophthalmology; 2015. p. 39–43; 5.Sumantra IG, Marzuki. Trombosis Sinus
Kavernosus. Jurnal Ilmiah Kedokteran. 2014;3(1):7–20; 6.Terni E, Giannini N, Chiti A, Gialdini G, Orlandi G, Montano V, et al. Cerebral Sinus Venous Thrombosis. Journal
Neuroscience Rural Practice. 2013;4:1; 7.Migirov L, Eyal A, Kronenberg J. Treatment of Cavernous Sinus Thrombosis. Israel Medical Journal. 2002;4(June); 8.Kline LB, Acker JD,
Donovan MJ, Vitek JJ. The Cavernous Sinus: A Computed Tomographic Study. 2001;(August):299–305; 9.Yen MT. Effect Of Corticosteroids In The Acute Management Of Pediatric
Orbita Cellulitis With Subperiosteal Abscess. 2005;21(5):363–7.