齲歯が原因で生じた感染性海綿静脈洞血栓症とLemierre症候群の合併例
症例は54歳女性．入院1年前に齲歯の治療中断歴があり，今回頭痛と発熱，眼窩部の腫脹疼痛を主訴に当科入院．両眼瞼浮腫と眼球運動障害以外に神経学的異常をみとめなかった．血液検査では炎症反応，凝固線溶系マーカーが上昇し，MRI拡散強調画像で右上眼静脈から海綿静脈洞に高信号がみられ，造影CTで同部位に造影不良域をみとめたことから，感染性海綿静脈洞血栓症と診断した．血液培養の結果から齲歯による敗血症を原因とする海綿静脈洞血栓症（cavernous sinus thrombosis; CST）と診断した．抗菌薬と抗凝固療法で治療を開始し，症状は軽快，画像上海綿静脈洞内の血栓も縮小した．本症例はMRIと造影...
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| Published in | 臨床神経学 Vol. 55; no. 7; pp. 483 - 489 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-000676 |
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| Abstract | 症例は54歳女性．入院1年前に齲歯の治療中断歴があり，今回頭痛と発熱，眼窩部の腫脹疼痛を主訴に当科入院．両眼瞼浮腫と眼球運動障害以外に神経学的異常をみとめなかった．血液検査では炎症反応，凝固線溶系マーカーが上昇し，MRI拡散強調画像で右上眼静脈から海綿静脈洞に高信号がみられ，造影CTで同部位に造影不良域をみとめたことから，感染性海綿静脈洞血栓症と診断した．血液培養の結果から齲歯による敗血症を原因とする海綿静脈洞血栓症（cavernous sinus thrombosis; CST）と診断した．抗菌薬と抗凝固療法で治療を開始し，症状は軽快，画像上海綿静脈洞内の血栓も縮小した．本症例はMRIと造影CTの画像所見からCSTを早期診断しえた貴重な症例である． |
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| AbstractList | 症例は54歳女性．入院1年前に齲歯の治療中断歴があり，今回頭痛と発熱，眼窩部の腫脹疼痛を主訴に当科入院．両眼瞼浮腫と眼球運動障害以外に神経学的異常をみとめなかった．血液検査では炎症反応，凝固線溶系マーカーが上昇し，MRI拡散強調画像で右上眼静脈から海綿静脈洞に高信号がみられ，造影CTで同部位に造影不良域をみとめたことから，感染性海綿静脈洞血栓症と診断した．血液培養の結果から齲歯による敗血症を原因とする海綿静脈洞血栓症（cavernous sinus thrombosis; CST）と診断した．抗菌薬と抗凝固療法で治療を開始し，症状は軽快，画像上海綿静脈洞内の血栓も縮小した．本症例はMRIと造影CTの画像所見からCSTを早期診断しえた貴重な症例である． |
| Author | 工藤, 仁隆 坪井, 義夫 緒方, 利安 西田, 明弘 深江, 治郎 福原, 康介 |
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| References | 27) Ito E, Saito K, Nagatani T, et al. Cavernous sinus thrombophlebitis caused by porphyromonas gingivalis with abscess formation extending to the orbital cavity. Case report. Neurol Med Chir 2009;49:370-373. 1) Desa V, Green R. Cavernous sinus thrombosis: current therapy. J Oral Maxillofac Surg 2012;70:2085-2091. 5) Aggarwal SK, Nath A, Singh R, et al. Lemierre’s Syndrome presenting with neurological and pulmonary symptoms: Case report and review of the literature. Ann Indian Acad Neurol 2013;16:259-263. 8) 澁谷航平，五十嵐修一，佐藤朋江ら．化膿性海綿静脈洞血栓症，細菌性髄膜炎をきたしたLemierre症候群の33歳男性例．臨床神経 2012;52:782-785. 7) Miller B, Khalifa Y, Feldon SE, et al. Lemierre syndrome causing bilateral cavernous sinus thrombosis. J Neuroophthalmol 2012;32:341-344. 19) Kahn JB, Baharestani S, Beck HC, et al. Orbital dissemination of Lemierre syndrome from gram-positive septic emboli. Ophthal Plast Reconstr Surg 2011;27:e67-68. 14) Brown LM, Wallwork B. Lemierre’s—the sinister sore throat. J Laryngol Otol 2007;121:692-694. 9) Stauffer C, Josiah AF, Fortes M, et al. Lemierre syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection associated with cavernous sinus thrombosis. J Emerg Med 2013;44:177-182. 15) Yamaguchi M, Nishizawa H, Yasumoto T, et al. Lemierre syndrome with blepharoptosis. Intern Med 2010;49:753-757. 18) Bababeygy SR, Almarzouki H, Buffenn AN. Isolated abducens nerve palsy secondary to Lemierre syndrome. J AAPOS 2011;15:587-589. 23) Morelli N, Rota E, Sacchini D, et al. Lemierre syndrome: more than “the forgotten disease”. Neurology 2013;81:1179-1180. 24) Favrole P, Guichard JP, Crassard I, et al. Diffusion-weighted imaging of intravascular clots in cerebral venous thrombosis. Stroke 2004;35:99-103. 3) Berdai AM, Shimi A, Khatouf M. Cavernous sinus thrombophlebitis complicating sinusitis. Am J Case Rep 2013;14:99-102. 21) Gutzeit A, Roos JE, Portocarrero-Fäh B, et al. Differential diagnosis of Lemierre’s syndrome in a patient with acute paresis of the abducens and oculomotor nerves. Korean J Ophthalmol 2013;27:219-223. 17) Vincent QB, Labedan I, Madhi F. Lemierre syndrome with meningo-encephalitis, severe cerebral artery stenosis, and focal neurological symptoms. J Pediatr 2010;157:345-345. e342. 26) Kraus CL, Culican SM. Challenging presentations of cavernous sinus thrombophlebitis. J Ophthalmic Inflamm Infect 2012;2:133-136. 10) Westhout F, Hasso A, Jalili M, et al. Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infartion. Case Report. J Neurosurg 2007;106:53-56. 20) Kraus CL, Culican SM. Challenging presentations of cavernous sinus thrombophlebitis. J Ophthalmic Inflamm Infect 2012;2:133-136. 16) Lim SC, Lee SS, Yoon TM, et al. Lemierre syndrome caused by acute isolated sphenoid sinusitis and its intracranial complications. Auris Nasus Larynx 2010;37:106-109. 4) Komatsu H, Matsumoto F, Kasai M, et al. Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report. Head Face Med 2013;9:9. 11) Jones TH, Bergvall V, Bradshaw JP. Carotid artery stenoses and thrombosis secondary to cavernous sinus thromboses in Fusobacterium necrophorum meningitis. Postgrad Med J 1990;66:747-750. 6) Saposnik G, Barinagarrementeria F, Brown RD, Jr., et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:1158-1192. 13) Touitou D, Deltour S, Bonneville F, et al. Hemiplegia in Lemierre syndrome: a neuroimaging strategy. Eur J Neurol 2006;13:424-426. 22) Golan E, Wong K, Alahmadi H, et al. Endoscopic sphenoid sinus drainage in Lemierre syndrome. J Clin Neurosci 2014;21:346-348. 2) Ebright JR, Pace MT, Niazi AF. Septic thrombosis of the cavernous sinuses. Arch Intern Med 2001;161:2671-2676. 12) Bentham JR, Pollard AJ, Milford CA, et al. Cerebral infarct and meningitis secondary to Lemierre’s syndrome. Pediatr Neurol 2004;30:281-283. 25) Imholz B, Becker M, Lombardi T, et al. Septic thrombosis of the cavernous sinus secondary to a Streptococcus milleri oral infection. Dentomaxillofac Radiol 2012;41:525-528. |
| References_xml | – reference: 17) Vincent QB, Labedan I, Madhi F. Lemierre syndrome with meningo-encephalitis, severe cerebral artery stenosis, and focal neurological symptoms. J Pediatr 2010;157:345-345. e342. – reference: 6) Saposnik G, Barinagarrementeria F, Brown RD, Jr., et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:1158-1192. – reference: 9) Stauffer C, Josiah AF, Fortes M, et al. Lemierre syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection associated with cavernous sinus thrombosis. J Emerg Med 2013;44:177-182. – reference: 1) Desa V, Green R. Cavernous sinus thrombosis: current therapy. J Oral Maxillofac Surg 2012;70:2085-2091. – reference: 10) Westhout F, Hasso A, Jalili M, et al. Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infartion. Case Report. J Neurosurg 2007;106:53-56. – reference: 26) Kraus CL, Culican SM. Challenging presentations of cavernous sinus thrombophlebitis. J Ophthalmic Inflamm Infect 2012;2:133-136. – reference: 4) Komatsu H, Matsumoto F, Kasai M, et al. Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report. Head Face Med 2013;9:9. – reference: 23) Morelli N, Rota E, Sacchini D, et al. Lemierre syndrome: more than “the forgotten disease”. Neurology 2013;81:1179-1180. – reference: 14) Brown LM, Wallwork B. Lemierre’s—the sinister sore throat. J Laryngol Otol 2007;121:692-694. – reference: 13) Touitou D, Deltour S, Bonneville F, et al. Hemiplegia in Lemierre syndrome: a neuroimaging strategy. Eur J Neurol 2006;13:424-426. – reference: 18) Bababeygy SR, Almarzouki H, Buffenn AN. Isolated abducens nerve palsy secondary to Lemierre syndrome. J AAPOS 2011;15:587-589. – reference: 16) Lim SC, Lee SS, Yoon TM, et al. Lemierre syndrome caused by acute isolated sphenoid sinusitis and its intracranial complications. Auris Nasus Larynx 2010;37:106-109. – reference: 11) Jones TH, Bergvall V, Bradshaw JP. Carotid artery stenoses and thrombosis secondary to cavernous sinus thromboses in Fusobacterium necrophorum meningitis. Postgrad Med J 1990;66:747-750. – reference: 15) Yamaguchi M, Nishizawa H, Yasumoto T, et al. Lemierre syndrome with blepharoptosis. Intern Med 2010;49:753-757. – reference: 27) Ito E, Saito K, Nagatani T, et al. Cavernous sinus thrombophlebitis caused by porphyromonas gingivalis with abscess formation extending to the orbital cavity. Case report. Neurol Med Chir 2009;49:370-373. – reference: 25) Imholz B, Becker M, Lombardi T, et al. Septic thrombosis of the cavernous sinus secondary to a Streptococcus milleri oral infection. Dentomaxillofac Radiol 2012;41:525-528. – reference: 7) Miller B, Khalifa Y, Feldon SE, et al. Lemierre syndrome causing bilateral cavernous sinus thrombosis. J Neuroophthalmol 2012;32:341-344. – reference: 22) Golan E, Wong K, Alahmadi H, et al. Endoscopic sphenoid sinus drainage in Lemierre syndrome. J Clin Neurosci 2014;21:346-348. – reference: 21) Gutzeit A, Roos JE, Portocarrero-Fäh B, et al. Differential diagnosis of Lemierre’s syndrome in a patient with acute paresis of the abducens and oculomotor nerves. Korean J Ophthalmol 2013;27:219-223. – reference: 12) Bentham JR, Pollard AJ, Milford CA, et al. Cerebral infarct and meningitis secondary to Lemierre’s syndrome. Pediatr Neurol 2004;30:281-283. – reference: 24) Favrole P, Guichard JP, Crassard I, et al. Diffusion-weighted imaging of intravascular clots in cerebral venous thrombosis. Stroke 2004;35:99-103. – reference: 3) Berdai AM, Shimi A, Khatouf M. Cavernous sinus thrombophlebitis complicating sinusitis. Am J Case Rep 2013;14:99-102. – reference: 5) Aggarwal SK, Nath A, Singh R, et al. Lemierre’s Syndrome presenting with neurological and pulmonary symptoms: Case report and review of the literature. Ann Indian Acad Neurol 2013;16:259-263. – reference: 19) Kahn JB, Baharestani S, Beck HC, et al. Orbital dissemination of Lemierre syndrome from gram-positive septic emboli. Ophthal Plast Reconstr Surg 2011;27:e67-68. – reference: 20) Kraus CL, Culican SM. Challenging presentations of cavernous sinus thrombophlebitis. J Ophthalmic Inflamm Infect 2012;2:133-136. – reference: 2) Ebright JR, Pace MT, Niazi AF. Septic thrombosis of the cavernous sinuses. Arch Intern Med 2001;161:2671-2676. – reference: 8) 澁谷航平，五十嵐修一，佐藤朋江ら．化膿性海綿静脈洞血栓症，細菌性髄膜炎をきたしたLemierre症候群の33歳男性例．臨床神経 2012;52:782-785. |
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| Snippet | 症例は54歳女性．入院1年前に齲歯の治療中断歴があり，今回頭痛と発熱，眼窩部の腫脹疼痛を主訴に当科入院．両眼瞼浮腫と眼球運動障害以外に神経学的異... |
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| SubjectTerms | Lemierre症候群 海綿静脈洞血栓症 齲歯 |
| Title | 齲歯が原因で生じた感染性海綿静脈洞血栓症とLemierre症候群の合併例 |
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