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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1815-1816, October 2006
© 2006 American Society of Neuroradiology

Case Report
HEAD & NECK

Restricted Diffusion in Bilateral Optic Nerves and Retinas as an Indicator of Venous Ischemia Caused by Cavernous Sinus Thrombophlebitis

J.S. Chen^a, P. Mukherjee^a, W.P. Dillon^a and M. Wintermark^a

^a From the Department of Radiology, Neuroradiology Section, University of California, San Francisco, Calif

Please address correspondence to Max Wintermark, MD, Department of Radiology, Neuroradiology Section, University of California, San Francisco, 505 Parnassus Ave, Box 0628, Room L-358, San Francisco, CA 94143-0628; e-mail: Max.Wintermark{at}radiology.ucsf.edu

SUMMARY: A 44-year-old man developed bilateral blindness following severe periorbital cellulitis and pansinusitis. CT and MR imaging demonstrated bilateral cavernous sinus thrombosis. Diffusion-weighted imaging revealed reduced apparent diffusion coefficient in bilateral optic nerves, suggesting optic nerve ischemia caused by the cavernous sinus thrombophlebitis (CST). Following surgical debridement of pansinusitis, antimicrobial therapy, and anticoagulation, the patient recovered from the infectious episode but sustained permanent bilateral blindness. This case shows that both retinal and optic nerve ischemia can be the cause of blindness after CST. Arguments supporting an arterial-versus-venous origin for the ischemia are discussed.

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