Diagnosis
Headache and fevers, sometimes with unilateral swelling over the face.
Epidemiologic Risks
Chronic sinusitis, brain abscess and occasionally trauma. The sinuses lie next to cranial nerves III, IV, V, and VI and can impinge upon them with cause paralysis of the extraocular muscles and painful ophthalmoplegia.
Bacteria travel down the valveless veins of the face to the cavernous sinuses.
Microbiology
Variable. S. aureus, streptococci, and anaerobes can all play a role (PubMed).
Empiric Therapy
Vancomycin PLUS metronidazole PLUS third-generation cephalosporins are reasonable pending cultures; whatever you give should have good penetration into the CSF.
Anticoagulation is an important adjunctive therapy decreasing complications.
Pearls
It can be difficult to diagnosis without an MRI or high-resolution CT.
Rants
Last Update: 06/04/18.