A 19 year old young girl with previous history of repeated pain over medial canthus and chronic use of nasal decongestants, presented with abrupt onset of fever with chills & rigor, diplopia on lateral gaze, moderate proptosis & chemosis. On examination optic disc is congested. Most likely diagnosis is:
A 19 year old young girl with previous history of repeated pain over medial canthus and chronic use of nasal decongestants, presented with abrupt onset of fever with chills & rigor, diplopia on lateral gaze, moderate proptosis & chemosis. On examination optic disc is congested. Most likely diagnosis is:
💡 Explanation
### **Core Concept**
Cavernous sinus thrombosis is a serious condition characterized by the formation of a blood clot in the cavernous sinus, a group of veins located near the base of the brain. This condition often results from a severe infection of the face, particularly the paranasal sinuses, or as a complication of a facial injury. The symptoms of cavernous sinus thrombosis can be nonspecific and include fever, headache, and vision changes, making it a challenging diagnosis to establish.
### **Why the Correct Answer is Right**
The patient's history of repeated pain over the medial canthus and chronic use of nasal decongestants suggests chronic sinusitis. The abrupt onset of fever with chills, diplopia on lateral gaze, proptosis, chemosis, and congested optic disc are indicative of cavernous sinus thrombosis. The thrombosis can cause impaired venous drainage, leading to increased pressure within the orbit, which in turn causes proptosis and chemosis. The thrombosis can also compress the cranial nerves III, IV, and VI, resulting in diplopia on lateral gaze.
### **Why Each Wrong Option is Incorrect**
**Option B:** Orbital cellulitis is an infection of the soft tissues of the orbit, which can cause proptosis and chemosis, but it does not typically cause diplopia on lateral gaze or congested optic disc.
**Option C:** Acute ethmoidal sinusitis is an infection of the ethmoidal sinuses, which can cause pain over the medial canthus, but it is unlikely to cause the severe symptoms described.
**Option D:** Orbital apex syndrome is a condition characterized by compression of the optic nerve and the oculomotor nerve (cranial nerve III), which can cause vision loss and diplopia, but it is not typically associated with cavernous sinus thrombosis.
### **Clinical Pearl / High-Yield Fact**
Cavernous sinus thrombosis is a medical emergency that requires prompt diagnosis and treatment. The condition can be diagnosed using imaging studies such as CT or MRI scans, and treatment typically involves antibiotics and anticoagulation therapy.