PMC8275649_01
Initial contrast-enhanced CT-Scan bone window, slice thickness 0.75 mm: partially obstructed mastoid air cells with a fully opacified, pneumatized petrous apex (triangle) on the left side (A). Initial contrast-enhanced CT-Scan soft tissue window, slice thickness 0.75 mm: Obstruction of the left cavernous sinus (dashed arrow), suspicious of cavernous sinus thrombosis (B).
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F1
A contrast-enhanced computed tomography (CT) revealed partially opacified mastoid air cells including a pneumatized petrosal apex on the left side and obstruction of the left cavernous sinus (Figure 1).
Initial MRI T1 DIXON FS post gadolinium. Dural enhancement (triangles) in the area of the left temporal lobe (A). Anteromedial rim enhancement of the opacified petrous apex (dashed arrow) (B). Thrombotic cavernous sinus and a marked vasculitis of the internal carotid artery (arrow) on the left side (C).
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F2
Magnetic resonance imaging (MRI) showed rim enhancement in the opacified petrous apex and dural enhancement in the area of the left temporal lobe which suggested PA (Figures 2A,B). Furthermore, cavernous sinus thrombosis and vasculitis of the left-sided internal carotid artery were described (Figures 2C, 3A).
Coronal view T1 DIXON FS post gadolinium, slice thickness 3 mm. Arrow: Cavernous sinus, Triangle: Pars cavernosa of the internal carotid artery. Initial MRI: Thrombosis of the cavernous sinus and involvement of the internal carotid artery with hyperemia of the vasa vasorum (A). MRI 7 days post-admission: Increasing inflammation of the internal carotid artery with further reduction in lumen size (B). MRI 14 days post-admission: Improvement of internal carotid artery involvement with a partial recovery in size (C). MRI 3 months post-admission: Complete recanalization of the left cavernous sinus and normal size of the left internal carotid artery (D).
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F3
Furthermore, cavernous sinus thrombosis and vasculitis of the left-sided internal carotid artery were described (Figures 2C, 3A). MRI was repeated 7 days post-admission and revealed a progressive thrombosis of the left cavernous sinus and vasculitis of the internal carotid artery (Figure 3B). Fourteen days after hospitalization, a marked improvement of symptoms and reduced obstruction of cavernous sinus on MRI were present (Figure 3C). Complete recanalization of the cavernous sinus and recovery of the internal carotid artery were shown and anticoagulant therapy could be stopped (Figure 3D).
Audiogram 3 days post-admission: moderate to severe combined hearing loss on the left with normal hearing on the right side (A). Audiogram at 3 months follow-up: Symmetrical normal hearing (B).
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F4
A small sensorineural aspect could be seen in the higher frequencies indicating a possible slight affection of the inner ear (Figure 4A). Audiologic testing revealed normal symmetrical hearing with resolved conductive and sensorineural aspect of hearing loss (Figure 4B).