Journal of Acute Disease
Cavernous sinus syndrome due to cavernous internal carotid artery dissection: A case report
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Abstract:
Rationale: Cavernous internal carotid artery dissection (ICAD) is a rare cause of cavernous sinus syndrome, presenting diagnostic challenges, particularly in resource-limited settings. Patient’s concern: A 43-year-old man presented with sudden, painless left eye blindness, partial ptosis and reduced facial sensation. Examination revealed a relative afferent pupillary defect, anisocoria, mild ophthalmoplegia and a pale optic disc. Initial computed tomography imaging was unremarkable, and lumbar puncture suggested meningoencephalitis. Despite treatment, his condition deteriorated to complete ptosis and total ophthalmoplegia. Urgent magnetic resonance imaging and computed tomography angiography confirmed cavernous internal carotid artery dissection and multiple areas of infarction.
Diagnosis: Cavernous sinus syndrome secondary to cavernous ICAD with non-arteritic ischemic optic neuropathy, total ophthalmoplegia and trigeminal nerve palsy.
Interventions: The patient initially received treatment for meningoencephalitis. Upon confirming the diagnosis of ICAD, he declined surgical intervention.
Outcomes: Irreversible left eye blindness.
Lessons: This case highlights the progressive nature of cavernous ICAD, the critical role of advanced imaging in diagnosis, and the need for clinical vigilance in resource-limited settings for timely diagnosis and intervention.
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