[P3-29] Septic Cavernous Sinus Thrombophlebitis in a Neonate with Disseminated Staphylococcal Infection: A Case Report
Cavernous sinus thrombosis/ thrombophlebitis is one of three basic syndromes affecting the dural sinuses. Limited data is available regarding the subject since it has become uncommon with the advent of antibiotics. Coupled with its protean clinical manifestations, delays in recognition and management has ensued, leading to profound neurologic sequelae and mortality. The paper presented a case of cavernous sinus thrombophlebitis in a neonate with disseminated staphylococcal infection, with a background of maternal perinatal infection. An eight- day old female was referred to neurology service due to progressive proptosis and ophthalmoplegia, associated with fever and jaundice beginning at the sixth day of life. Neurologic exam revealed a frozen right orbit with absent corneal reflex and purulent discharge, and a left orbit with intact extraocular muscles and corneals. The patient also presented with right-sided hemiparesis. Cranial ultrasound revealed abscesses versus infarction, with Doppler studies supportive of superior sagittal sinus thrombosis. Cranial MRI further showed involvement of the cavernous sinus and delineated the extent of both the abscesses and infarction. Conservative management with prolonged and high-dose Vancomycin and Meropenem was successful in resolving the infection and limiting disability. Heparinization was contemplated but was not done due to initial signs of disseminated intravascular coagulation owing to sepsis. The rare occurrence of cavernous sinus thrombophlebitis in a neonate with overwhelming infection was described, adding to the current limited data on the matter. It has further demonstrated the utility of cranial ultrasound in the screening and monitoring of these subset of patients.