Sinus cavernosus-trombose en hersenabces als complicatie van een tandabces

Abstract

Cavernous sinus thrombosis and brain abscess as a complication of a dental abscess A cavernous sinus thrombosis and brain abscess are rare complications of a dental abscess with a possibly fatal outcome. Therefore, timely and adequate treatment of the cause is important. This case describes a 50-year-old patient who presented to the emergency department with a sudden ptosis of the right eyelid after having suffered for 1,5 months from a dental abscess for which only alternative medicine was applied. Clinical examination showed a dysfunction of the oculomotor nerve and the abducens nerve on the right, and of the abducens nerve on the left. The diagnosis of a cavernous sinus thrombosis and brain abscess were made on an MRI. The brain abscess was drained and antibiotics, initially penicillin and metronidazole IV, later meropenem IV, were started against the multiple anaerobic germs. Anticoagulants were initiated to treat the sinus cavernosus thrombosis and to prevent further cerebral venous embolisation. Ten days later, the patient only showed a partial bilateral abducens paresis, which correlated with the follow-up MRI of the brain, revealing osteomyelitis of the clivus on the course of the abducens. Over-reliance on alternative medicine can be dangerous, especially in those cases where antibiotic therapy is necessary.