Review Question - QID 104442

This patient is presenting with a fever, chills, exophthalmos, decreased vision, and abnormalities of cranial nerves III, V, and VI suggesting a diagnosis of cavernous sinus thrombosis.

Cavernous sinus thrombosis typically follows infections of the skin of the eye and nose or sinusitis. Patients will present with fevers, chills, nausea/vomiting, headache, blurred vision, cellulitis surrounding the eye, exophthalmos, paralysis of cranial nerves III and VI, and in severe cases, altered mental status, lethargy, and meningeal signs. The management of cavernous sinus thrombosis is an MRI with MR venogram (diagnostic test of choice), a CT head/orbits with IV contrast (less accurate), and blood cultures. The treatment of this condition is IV antibiotics (typically broad-spectrum antibiotics such as vancomycin and piperacillin-tazobactam), heparin if there is decompensation and neurosurgical intervention.

Figure A is the physical exam finding of periorbital cellulitis.

Incorrect Answers:
Answer 1: Acute closed-angle glaucoma presents with severe unilateral eye pain, blurry vision, visual halos, headache, nausea, and vomiting and is treated with timolol, brimonidine, acetazolamide, pilocarpine, and an irodotomy.

Answer 2: Brain abscess presents with a fever, a headache, and focal neurological deficits with an abscess seen on head imaging.

Answer 4: Periorbital cellulitis presents with pain and swelling/erythema surrounding the orbit without pain with extraocular movements or vision changes.

Answer 5: Intracranial hemorrhage presents with a sudden onset headache and possible focal neurologic deficits with gradual worsening of the patient's mental status and obtundation if the bleed is severe.

Bullet Summary:
Cavernous sinus thrombosis presents with fever, chills, exophthalmos, decreased vision, and abnormalities of cranial nerves III, V, and VI.