Korean J Ophthalmol.  2010 Oct;24(5):322-324. 10.3341/kjo.2010.24.5.322.

Complete Visual Recovery after Mycotic Aneurysm Embolization Complicated by Cavernous Sinus Thrombophlebitis

• Kim US
• Kim JS
• Kwon OK
• Hwang JM

• KMID: 974330
• DOI: http://doi.org/10.3341/kjo.2010.24.5.322

Abstract

A 62-year-old woman has been suffered from cavernous sinus thrombophlebitis which was confirmed by four-vessel angiography, orbit magnetic resonance imaging, and blood culture. Three weeks after recovery of cavernous sinus thrombophlebitis, right eye proptosis and complete third, fourth, and sixth cranial nerve palsies developed. Best-corrected visual acuity decreased to 20/70 in the right eye. Repeat magnetic resonance imaging demonstrated a 1.5-cm-sized mass in the right cavernous sinus, suspicious for mycotic aneurysm. Amphotericin B supplementation was begun and was followed by successful transarterial Guglielmi detachable coil embolization. Four months later, extraocular movement was normalized, and visual acuity improved to 20/25 in the right eye.

Keyword

Cavernous sinus thrombosis; Guglielmi detachable coils embolization; Mycotic aneurysm

MeSH Terms

Amphotericin B/therapeutic use
Aneurysm, Infected/*etiology/*therapy
Angiography
Antifungal Agents/therapeutic use
Cavernous Sinus Thrombosis/*complications
Embolization, Therapeutic/*methods
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Visual Acuity

Figure

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  Fig. 1 Gadolinium-enhanced magnetic resonance imaging shows enhancement in the right cavernous sinus in the fat-suppressed T1-weighted axial image (A) and T1-weighted sagittal image (B).

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  Fig. 2 (A) Four-vessel angiography reveals that the cavernous sinus is not filled in the delayed views, and venous engorgement and stasis are shown (arrow). (B) Soft exudates and splinter hemorrhage are noted upon fundus examination. (C) Mycotic aneurysm is located at the cavernous sinus portion upon digital four-vessel angiography (arrow). (D) Guglielmi detachable coil embolization is performed successfully without the remaining aneurysm (arrow).

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