Idiopathic Cavernous Sinus Thrombosis Presenting Unilateral Abducens Nerve Palsy

Abstract

Background: Cavernous sinus thrombosis is usually caused by infection, such as sinusitis and dental or facial infections. Idiopathic cavernous sinus thrombosis is very rare. We report a patient diagnosed as idiopathic cavernous sinus thrombosis presenting with unilateral abducens nerve palsy and headache. Case Report: A healthy 46-year-old man presented with abrupt severe headache and developed horizontal diplopia 7 hours after onset of the headache. On neurologic examination, ophthalmoplegia of his left eye was compatible to left abducens nerve palsy. Brain magnetic resonance imaging revealed a 10.6 mm contrast defect lesion in the left side of the cavernous sinus. He was diagnosed as cavernous sinus thrombosis. Lab study showed no evidence of infection, coagulopathy or autoimmune disorder. We started treatment with heparin and intravenous dexamethasone, which lessened the headache and diplopia. Conclusion: To our knowledge, this is the first report of idiopathic cavernous sinus thrombosis in Korea. Anticoagulation and steroid therapy have an effect on idiopathic cavernous sinus thrombus.

Keywords

• Idiopathic cavernous sinus thrombosis
• Abducens nerve palsy
• Treatment