A Case of Infective Caver...

History: The patient in this case is a 53 year old male with Diabetes Mellitus as known comorbidity suffered electrocution (entry : right hand and exit site : nose) 2 months back. Following the electric injury after 10 days he developed purulent ear discharge in right ear, headache, diplopia and progressive diminution of vision in right eye. Over a period of 10 days after following symptoms he developed right sided LMN type facial nerve palsy and complete Ophthalmoplegia.

Evaluation : On examination:Involvement of Cranial Nerves – III,IV, V leading to complete unilateral right side ophthalmoplegia. (Figure 1 & 2) Involvement of V1 and V2 divisions of Trigeminal nerve leading to absence of sensations on right side of face. Involvement of Facial nerve leading facial asymmetry, loss of nasolabial folds on right side and mouth deviation left side.

Investigations : Image – 1 : Right Cavernous sinus is widened showing enhancement of soft tissue component on Contrast MRI

2 : Soft tissue enhancement seen at sphenoid sinus , clivus/base of skull

3 : Fluid in mastoid air cells suggestive of mastoiditis

4 : Soft tissue enhancement in infra temporal fossa and sphenoid wings On above based MRI images he was diagnosed as a case of Infective Cavernous sinus thrombosis. CT images : suggestive of skull base osteomyelitis

Management : He was started broad spectrum antibiotics and anti fungals initially and replaced them with culture sensitive antibiotics along with anticoagulation.