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Cavernous sinus thrombosis — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsCavernous sinus thrombosisSCE Acute Medicine

A 34-year-old man presents with fever, severe headache and painful swelling around the right eye after facial cellulitis. He has proptosis, chemosis and impaired right eye abduction. CRP is 210 mg/L. What is the most appropriate investigation?

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Correct answer: A — Urgent contrast-enhanced MRI or CT venography

Fever, orbital signs and sixth nerve palsy after facial infection suggest cavernous sinus thrombosis, needing urgent contrast venous imaging and antimicrobial treatment. D-dimer is not a safe rule-out test for this presentation. Plain radiography is obsolete for this emergency. The pearl is that cranial nerve VI palsy is often an early sign because of its position in the cavernous sinus.

Reference: NICE CKS sinusitis; neuro-ophthalmology emergency guidance