Septic cerebral venous sinus thrombosis from maxillary sinusitis with concomitant right-sided sigmoid sinus hypoplasia: A case report and review of the literature

Abstract

Septic cerebral venous sinus thrombosis (CVST) is a rare, yet life-threatening condition, with an estimated annual incidence of fewer than 5 cases per million. Diagnosing and managing CVST is challenging due to its varied clinical presentation. This report details a rare case of septic dural sinus thrombosis, notable for its association with right side sigmoid sinuses hypoplasia. Additionally, we highlight a seldom-examined imaging characteristic: a notable size discrepancy between the left and the right internal jugular veins. A 29-year-old Ethiopian female with Crohn's disease, on immunosuppressant, presented with progressive frontal headache, right eye ptosis, periorbital edema, and numbness. Initial computed tomography (CT) scans revealed cavernous and transverse sinus thrombosis with right maxillary sinus opacification with air-fluid level. She was diagnosed with maxillary sinusitis complicated by septic cavernous and transverse sinus thrombosis. However, despite aggressive medical management, including anticoagulation, broad spectrum antibiotic and antifungal therapy for suspected rhino-orbito-cerebral mucormycosis, she succumbed to her illness on the fourth day of admission. This case highlights the complex diagnostic and treatment difficulties linked to cerebral venous sinus thrombosis, especially in resource-limited setting where access to high-sensitivity imaging techniques is limited. An imaging finding of enlarged left internal jugular vein, paradoxically larger than the right internal jugular vein, when considered alongside relevant clinical information, should prompt clinicians to be vigilant for potential venous drainage via collaterals. Such alterations may arise from factors such as CVST or from intrinsic venous drainage variations, including hypoplasia of the nondraining dural sinuses.