Cavernous sinus and internal carotid artery thrombosis with multipl cranial nerves paralysis in a diabetic patient

Abstract

Cavernous sinus thrombosis (CST) is a life-threatening event, and its major etiologic factor is considered as infection. This case is presented as it is a rare event of CST and internal carotid artery thrombosis (ICAT) secondary to odontogenic infection in a diabetic patient. The computed tomography (CT) and magnetic resonance imaging (MRI) examinations on the paranatal sinus and neck of the patient, who is a 50 years old female and diabetic for over 8 years, presenting to our clinic with left hemiparesis, right total opthalmoplegia, right facial paralysis, edema and pain on the right side of the face, demonstrated right CST, ICAT and infiltration of pterygopalatine and infratemporal fossa. Biopsies were obtained from right pterygopalatine fossa and paranasal sinus, and resulted in chronic inflammatory granulation tissue. The patient received antibotics and lower molecular weight heparin, which was followed by relief of symptoms. During the control MRI, no change was observed except the partial regression in the sinuses and temporal bone. The nonspecific tooth-induced infection was considered as the etiologic factor. In conclusion, odontogenic infections and soft tissue infections must not be overlooked and must be treated carefully in patients with predisposing factor such as diabetes mellitus.

Keywords

• cavernous sinus
• thrombosis
• diabetes mellitus.