Use of dexamethasone in septic cavernous sinus thrombosis coexisting with bacterial meningitis secondary to sinusitis: A case report
We present the case of a 69-year-old woman who developed septic cavernous sinus thrombosis (SCST) secondary to bacterial meningitis and sinusitis. She presented to the emergency department with frontal headache, neck stiffness, photophobia, exophthalmos, and fever. Initial investigations revealed extensive opacification of the paranasal sinuses on plain cranial computed tomography (CT), and blood tests indicated a bacterial infection. She initially received antibiotics and dexamethasone for suspected bacterial meningitis. Cerebrospinal fluid analysis revealed elevated glucose and protein levels as well as white and red blood cell counts, along with a negative Gram stain. An ophthalmology assessment and CT venography indicated a strong suspicion of cavernous sinus thrombosis, further confirmed by magnetic resonance venography. Anticoagulation with antibiotics and dexamethasone was initiated, leading to significant clinical improvement. This case highlights the importance of the early recognition and treatment of SCST and the role of dexamethasone in patients with coexisting bacterial meningitis.
- Plewa MC, Tadi P, Gupta M. Cavernous Sinus Thrombosis. In: StatPearls. StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448177 [Last accessed on 2024 Jul 21].
- Hoshino C, Satoh N, Sugawara S, Kuriyama C, Kikuchi A, Ohta M. Septic cavernous sinus thrombosis complicated by narrowing of the internal carotid artery, subarachnoid abscess and multiple pulmonary septic emboli. Intern Med. 2007;46(6):317-323. doi: 10.2169/internalmedicine.46.6202
- Jacob M, Gunasekaran K, Miraclin A, et al. Clinical profile and outcome of patients with cerebral venous thrombosis secondary to bacterial infections. Ann Indian Acad Neurol. 2020;23(4):477-481. doi: 10.4103/aian.AIAN_341_20
- Bhatia K, Jones NS. Septic cavernous sinus thrombosis secondary to sinusitis: Are anticoagulants indicated? A review of the literature. J Laryngol Otol. 2002;116(9):667-676. doi: 10.1258/002221502760237920
- Deliran SS, Brouwer MC, Coutinho JM, Van De Beek DV. Bacterial meningitis complicated by cerebral venous thrombosis. Eur Stroke J. 2020;5(4):394-401. doi: 10.1177/2396987320971112
- Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: A review. Surv Ophthalmol. 2021;66(6):1021-1030. doi: 10.1016/j.survophthal.2021.03.009
- Levine SR, Twyman RE, Gilman S. The role of anticoagulation in cavernous sinus thrombosis. Neurology. 1988;38(4):517-517. doi: 10.1212/WNL.38.4.517
- Weerasinghe D, Lueck CJ. Septic cavernous sinus thrombosis: Case report and review of the literature. Neuroophthalmology. 2016;40(6):263-276. doi: 10.1080/01658107.2016.1230138
- Coutinho J, De Bruijn SF, De Veber G, Stam J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst Rev. 2011;2011:CD002005. doi: 10.1002/14651858.CD002005.pub2
- Akarapas C, Wiwatkunupakarn N, Sithirungson S, Chaiyasate S. Anticoagulation for cavernous sinus thrombosis: A systematic review and individual patient data meta-analysis. Eur Arch Otorhinolaryngol. 2024. doi: 10.1007/s00405-024-08992-4
- Einhäupl K, Stam J, Bousser MG, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010;17(10):1229-1235. doi: 10.1111/j.1468-1331.2010.03011.x
- Desa V, Green R. Cavernous sinus thrombosis: Current therapy. J Oral Maxillofac Surg. 2012;70(9):2085-2091. doi: 10.1016/j.joms.2011.09.048
- Ivey KJ, Smith H. Hypopituitarism associated with cavernous sinus thrombosis. Report of a case. J Neurol Neurosurg Psychiatry. 1968;31(2):187-189. doi: 10.1136/jnnp.31.2.187
- Solomon DO, Moses L, Volk M. Steroid therapy in cavernous sinus thrombosis. Am J Ophthalmol. 1962;54(6):1122-1124. doi: 10.1016/0002-9394(62)94356-8
- Canhão P, Cortesão A, Cabral M, et al. Are steroids useful to treat cerebral venous thrombosis? Stroke. 2008;39(1):105-110. doi: 10.1161/STROKEAHA.107.484089
- Dinaker M, Sharabu C, Kattula SR, Kommalapati V. A case of cavernous sinus thrombosis with meningitis caused by community acquired methicillin resistant Staphylococcus aureus. J Assoc Physicians India. 2014;62(5):436-438.