A 30-year-old female presented to the emergency department of the hospital with diffuse headache and bilateral proptosis, which was associated with vomiting. There was no ear discharge, cough, or burning micturition. There was no history of trauma, or seizures. She had no past history of convulsions or tuberculosis. She had no history of sickle cell disease, hypertension, and diabetes. She was P2L2A0 and the previous deliveries were normal without any complicating events.
On examination, she was conscious, but drowsy with low-grade fever.glasgow coma scale was 9 at the time of admission. She was pale and anicteric. Her pulse was 120/min and regular. Her blood pressure on admission was 130/90 mmHg in left upper limb supine position. Main neurological finding was left third nerve palsy with papilloedema.
Local examination of eyes showed bilateral proptosis which was associated with chemosis and corneal haziness. Other systemic examination was unremarkable. Her hemoglobin was 8.5 gm/dl, hematocrit was 26%, total leukocyte counts were 15,000 per cubic mm. Blood culture was sterile. Platelets were normal. There was no sickle cell on peripheral smear. There was no deficiency of protein C or S. Antiphospholipids antibody was normal. Her chest film was normal. Patient underwent plain and post-contrast computed tomography (CT) head scan which showed bilateral superior ophthalmic vein thrombosis extending to the thrombosed cavernous sinus [Figure 1]. There was also right subdural hematoma (appears to be chronic) with midline shift [Figure 2]. There was no sign of cerebritis (heterogeneous enhancing area in adjoining hypodense area) in adjacent cerebral parenchyma, so chances of empyema were less likely. On the basis of this CT scan findings and clinical feature, we treated the patients with higher antibiotics in the form of combination of sulbactum and ceftrixone intravenously twice a day and corticosteroids. Heparin was started in view of high-risk benefit ratio of cavernous sinus thrombosis and subdural hematoma. Neurosurgical consultation was also taken, hematoma (there were no evidence of pus) was evacuated. In spite of all, patient did not show any improvement and died subsequently. We did not send her for autopsy due to resistance by her relatives.