Horner Syndrome and Abducens Nerve Palsy secondary to Lemierre Syndrome
Author: Katherine Lucarelli
Base Hospital / Institution: University of California, Los Angeles
ePoster presentation
Abstract ID: 24-275
Purpose
Lemierre syndrome is a life-threatening condition characterized by bacteremia, internal jugular vein thrombophlebitis, and septic emboli secondary to acute pharyngeal infections. Severe cases may include ophthalmic manifestations. The authors present a case of Horner syndrome, abducens palsy, and ophthalmic vein thrombosis secondary to Lemierre.
Methods
Case report and literature review
Results
A 19-year-old man presented with diplopia, aphasia, and bilateral upper extremity weakness. Magnetic resonance imaging (MRI) showed bilateral cerebral infarcts with left internal carotid artery (ICA) occlusion, right ICA dissection, and a left retropharyngeal fluid collection. An extensive infectious and serologic workup was initially unrevealing, and he became febrile and encephalopathic despite broad-spectrum antimicrobials and anticoagulation. Subsequent neuroimaging revealed progression with clival osteomyelitis and epidural extension, right internal jugular vein thrombosis, bilateral cavernous sinus and right superior ophthalmic vein thrombosis. Ophthalmic examination revealed right ptosis, anisocoria with right miosis, and a right abduction deficit. The anterior and posterior segment exams were otherwise normal. On hospital day eight, fusobacterium necrophorum was detected, and the patient was diagnosed with Lemierre syndrome. He stabilized on targeted antibiotics and was discharged to an acute rehabilitation center. Right ptosis and the right abduction deficit were persistent and were managed expectantly.
Conclusion
This patient’s Horner syndrome and abduction deficit were attributed to cranial nerve VI and sympathetic chain disruption from cavernous sinus thrombosis. In addition to cavernous sinus and ophthalmic vein thrombosis, orbital abscess, vitreous hemorrhage, septic embolism and endophthalmitis have been described in Lemierre syndrome. Ophthalmic complications reflect underlying cerebral vein thrombosis and thus indicate severe disease requiring multidisciplinary care.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Robert | Goldberg | University of California, Los Angeles |
| Daniel | Rootman | University of California, Los Angeles |
