The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Cavernous sinus thrombosis

Photo by Dr. Tan Aik Kah

A 15 year-old girl was bitten by an unknown insect to her right forehead. The site became infected and she pinched and tried to express the small abscess. Two days later she developed a sudden right complete ptosis. Examination revealed poor ocular motility involving mainly the muscles supplied by the oculomotor nerve. An urgent MRI scan with contrast revealed filling defect in the right cavernous sinus which was hyperintense on T1 view and hypointense on T2 view suggestive of subacute thrombosis which displaced the internal carotid artery laterally. The area was enhanced heterogeneously following intravenous gadolinium. She was started on intravenous antibiotics and heparin.

 

Right ptosis and inflammed right upper eyelid.

 

Limitation of the right ocular movement especially on adduction, up and downgaze.

 

Filling defect in the right cavernous sinus.

 

Heterogenous enhancement of the right cavernous sinus following gadolinium injection.

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