Septic thrombosis of the cavernous sinus secondary to meningitis: case report from a referral hospital in Espirito Santo

Case presentation: Female patient, 1 year and 7 months old, previously healthy, presented cervical adenomegaly, fever, periorbital edema after receiving MMR vaccine. She evolved with a deviation of the labial commissure to right, neck stiffness, bilateral edema. On hospital admission, she normal cranial tomography infectious cerebrospinal fluid negative culture. had generalized onset tonic-clonic motor crisis anisocoria (L>R), left hemiparesis side hypotonia, ptosis, ophthalmoplegia. The blood culture was positive for Sthapylococcus aureus. MRI brain performed, findings compatible thrombophlebitis cavernous sinuses, associated thrombosis superior ophthalmic veins, right sigmoid sinus, internal jugular vein, areas ischemic vascular injury predominantly in parietal lobes bilaterally epidural collection at anteromedial margin middle fossa, suggestive empyema. Anticoagulation not performed due etiology condition. An angioresonance 20 days antibiotic therapy showed signs partially recanalized along sinus bulb vein absence discharged from using anticonvulsants. Currently, is being followed up neurology outpatient clinic, progressive clinical improvement peripheral facial nerve palsy, complete third ophthalmoparesis, addition hemiparesis.