Cavernous sinus thrombosis followed by brain ischaemia in a type-1 diabetic patient: a persistent endodontic infection report.

Central nervous system infections and cavernous sinus thrombosis are associated with high mortality rates and may be a consequence of oral infection propagation. A 24-year-old woman has attended a private dental office with a pain complaint in the upper right central incisor and had the endodontic treatment completed. However, the patient returned to the dental office reporting pain in the same tooth and the presence of swelling. Then, the root canal was retreated. After one week, the patient presented to a Basic Health Unit with a history of vomiting and convulsion crisis followed by loss of consciousness. A computed tomography exam showed cavernous sinus thrombosis and brain ischaemic areas. The present report describes a rare case of cavernous sinus thrombosis followed by brain ischaemia in a type-1 diabetic patient, associated with persistent endodontic infection, with subsequent patient's death.

Trombose séptica do seio cavernoso e meningite numa adolescente de 13 anos / Septic thrombosis of the cavernous sinus associated to meningitis in a 13-years-old adolescent

Destaca-se grave trombose séptica do seio cavernoso (TSSC), em adolescente. Não raro, esta entidade é subdiagnosticada e tratada inadequadamente. O caso é de uma jovem de 13 anos, que desenvolveu TSSC e meningite, após espremer uma “espinha” do rosto, evoluindo com disartria e distúrbios oculares. A TSSC é relativamente incomum, se considerarmos a freqüência de processos infecciosos que desencadeiam essa grave obstrução da circulação venosa cerebral, causando febre, cefaléia, vômitos, celulite periorbitária, proptose, lesão de pares cranianos, etc., podendo levar à cegueira ou à morte. Também serão comentados detalhes anatômicos, a etiologia, o diagnóstico e o tratamento desta patologia.

Orbital and periorbital infections.

Infections of the orbit and periorbital tissues are not uncommon. Trauma, skin infections, and sinusitis are frequently the underlying cause. Studies have shown changes in epidemiology and pathogens in the last decade. Although classical manifestations are usually present, atypical cases without specific signs and symptoms may confound the diagnosis. A high index of suspicion, aided by ultrasonography, computed tomography, and magnetic resonance imaging, is frequently required for an accurate diagnosis. Prompt diagnosis and treatment may lead to resolution of the infection, thus avoiding ocular sequelae. Orbital infections may spread into the globe, causing endophthalmitis. Some patients may even need an enucleation or evisceration. New materials and techniques may improve the final result of an anophthalmic socket.