Abstract
The authors reported a case of rhinogenic sinus cavernous thrombosis, spreaded into sigmoid sinus land internal jugular vein, discussed its diagnosis and treatment.
The case was 28 years female suffering from acute onset severe frontal headache, high fever (39°), left exophthalmos. Rhinoscopic and x-ray examination suggested left acute purulent sinusitis. In spite of Luc-Caldwell maxillo-ethomoidectomy and extranasal frontal sinus operation and antibiotics, remittent fever, slight stiffness of neck, inflammatory swelling of left lateral neck along internal jugular vein, granulation from posterior auditory canal appeared. Chemosis, diminished visual acuity, left III IV VI cranial nerve disturbances were recognized. Cerebrospinal fluid finding showed aseptic meningeal reaction, left Queckenstedt Sign was positive.
Second operation of internal jugular vein ligation, mastoid and sigmoid sinus opening had done, and thrombophlebitis of internal jugular vein and sigmoid sinus, mastoiditis were confirmed.
The patient had dramatical recovery after the second operation, left the hospital 3 weeks later, but left blindness, III IV VI cranial nerve disturbances did'nt healed.
In relation to the effect of venous ligation and removal of clotted blood, we supposed supprative focus would be in sigmoid sinus, purulent blood would flow in general circulation system, and about the propriety of anticoagulant treatment discussed.
Long coursed cavernous sinus thrombosis would not seldom extend to sigmoid sinus and internal jugular vein, so observation on these area is important. On the extended case the ligation of vein or the removal of supprative focus must be done at the proper stage.
