Abstract
A 66-year-old man was admitted due to internal and external ophthalmoplegia six days after developing headache and nausea. On gadolinium-enhanced magnetic resonance image, bilateral cavernous sinuses and superior orbital veins were not enhanced, which suggested cavernous sinus thrombosis. The left cavernous sinus contained an aneurysm of the internal carotid artery. Cerebral spinal fluid demonstrated pleocytosis of polymorphonuclear leukocytes and decreased glucose level, which suggested bacterial meningitis. After we started anticoagulants and antibiotics, the right cavernous sinus thrombosis and meningitis improved, but aneurysm of the left cavernous sinus enlarged and infectious aneurysms appeared on his cerebral cortex. Continuation of only antibiotics resulted in reduction of these aneurysms, but the left cavernous sinus thrombosis was not dissolved and left ophthalmoplegia remained. His sphenoid bone had defective areas on the upper wall, through which bacteria of sinusitis were assumed to have invaded and thrombosed the cavernous sinus. It was also assumed that bacterial thrombus influenced the meninges and internal carotid artery, thereby causing meningitis and aneurysm, which became an embolic source of infectious aneurysms on his cerebral cortex. Although cavernous sinus thrombosis is infrequent since the advent of antibiotics, it is necessary to pay attention to its development in people with defective sphenoid bone.
