Rev Bras Oftalmol.2026;85:e0107
Cavernous sinus thrombosis in a child: differential diagnosis and multidisciplinary management
DOI: 10.37039/1982.8551.20260107
ABSTRACT
The objective of this report was to describe a case of cavernous sinus thrombosis (CST) in a pediatric patient, emphasizing diagnostic challenges and the importance of a multidisciplinary approach. The case report is based on clinical, ophthalmological, laboratory, and imaging findings, including magnetic resonance imaging and magnetic resonance angiography, assessed at different stages of clinical evolution. A 10-year-old female patient presented with progressive headache, painful ophthalmoplegia, proptosis, and unilateral visual loss. The initial diagnosis was Tolosa-Hunt syndrome, with no clinical response to corticosteroid therapy. Magnetic resonance angiography revealed absence of venous flow in the left cavernous sinus, confirming CST. After initiation of full anticoagulation, clinical improvement and neurological stabilization were observed, with residual visual impairment. CST should be included in the differential diagnosis of painful ophthalmoplegia in children. Early vascular imaging and multidisciplinary management are essential to prevent diagnostic delays and reduce neurological and visual sequelae.
