Page 110 - ITPS-8-1

INNOSC Theranostics and
Pharmacological Sciences Steroids in septic cavernous thrombosis

prothrombotic properties, and tendency to exacerbate studies, particularly randomized controlled trials, may
infection by suppressing the immune response. The benefits help clarify its benefits.
of decreasing orbital inflammation, cranial nerve edema,
vasogenic edema, and intracerebral hemorrhage must 4. Conclusion
be weighed against the adverse effects of corticosteroids. This case highlights the importance of early identification and
Despite limited literature supporting improved outcomes aggressive management of SCST. The patient’s substantial
following corticosteroid administration, some studies have improvement may have been facilitated by the use of
reported improved cranial nerve function resulting from dexamethasone alongside antibiotics and anticoagulation.
decreased inflammation. Notably, Ivey and Smith (1968) Despite the controversial role of corticosteroids in SCST,
4,12
reported the usefulness of corticosteroids in treating adrenal their administration in severe inflammation contributed to
insufficiency caused by pituitary dysfunction resulting a positive outcome. This case supports the consideration
from infarction or infectious spread from the cavernous of corticosteroids in similar clinical scenarios while
sinus to sella turcica in the CST setting. In 1962, Solomon emphasizing the need for further research into their role
13
et al. reported a case of CST that was diagnosed on hospital alongside conventional treatments in complex conditions
day 9. The condition of the patient progressed from such as SCST coexisting with meningitis. It also highlights
unilateral, bilateral CST, with absolute ophthalmoplegia the importance of a multidisciplinary approach in its
and bilateral ocular orbital inflammation over 6 weeks diagnosis and management.
despite aggressive antibiotic and anticoagulation therapies.
The patient subsequently showed improvement 2 days after Acknowledgments
the commencement of oral corticosteroids. In this case, The authors would like to thank Dr David Newsome,
14
the infection might have been eliminated before starting consultant stroke physician, and colleagues from the
corticosteroids, as they were initiated on day 37 when the Department of Radiology, University Hospital of North
clinical signs of sepsis had already subsided. Durham, United Kingdom, for their valuable contributions.
In 2008, Canhão et al. reported on the use of
corticosteroids in CVT. Of the 624 adult patients included Funding
in the International Study on Cerebral Veins and Dural None.
Sinus Thrombosis, 24% received corticosteroids with a
median duration treatment of 11 days. They did not find Conflict of interest
evidence supporting the routine use of corticosteroids The authors declare that they have no competing interests.
in the acute phase of CVT, except if indicated for
treating an underlying disease other than CVT requiring Author contributions
corticosteroids. Corticosteroids were reported as possibly
harmful and should be avoided in patients with CVT Conceptualization: Wesam Albqa’een, Nikesh K Giri
without CT or MRI evidence of parenchymal lesions. Investigation: Wesam Albqa’een, Nikesh K Giri
15
Conversely, in 2014, Dinaker et al. reported a case of Writing – original draft: Wesam Albqa’een, Nikesh K Giri
SCST with meningitis caused by community-acquired Writing – review & editing: Revin Thomas, Gemma Smith
methicillin-resistant S. aureus, where the patient received Ethics approval and consent to participate
antibiotics, anticoagulants, and dexamethasone, leading
to rapid response and symptom resolution. At discharge, Verbal consent was obtained from the patient before her
the patient had mild residual right hemiparesis and participation.
demonstrated full recovery at the 3-month follow-up. 16
Consent for publication
Given the rarity of SCST and limited literature
regarding corticosteroids, we extrapolated data from Verbal consent was obtained from the patient to publish
other CVT studies and articles to help expand this topic. her data and scan images.
In our case, the patient showed significant improvement Availability of data
with corticosteroids and had no neurological deficit.
Dexamethasone likely contributed to inflammation Not applicable.
reduction, enhancing overall recovery. This supports the
potential benefit of corticosteroids in managing CST with References
concurrent bacterial meningitis, where inflammation plays 1. Plewa MC, Tadi P, Gupta M. Cavernous Sinus Thrombosis.
a critical role in symptomatology. However, further larger In: StatPearls. StatPearls Publishing; 2024. Available from:

Volume 8 Issue 1 (2025) 104 doi: 10.36922/itps.4853