Friday, July 11, 2008


Paulus was admitted last weekend by Ravi, a visiting ER doc. His father told us that 2 wks prior he developed an infection of his lower lip, that turned into an abcess. He didn't seek medical treatment, and afterwards started developing a headache, and fever. After this, his started to swell and he had trouble seeing, then he got confused. They brought him to us when he got the confusion.

Ravi, having never seen it, but having read about it, diagnosised him with cavernous sinus thrombosis. We don't have a CT scan or MRI to confirm this, but we are working off it. Although Ravi admitted him, I get to take care of him. Like Ravi, I had never seen of it, but remember being warned about it in residency, especially with infections in the middle third of the face. The cavernous sinus drains the middle part of the face, and directly communicates with the dura, so an infection can lead to meningitis. Occlusion of the venous blood flow can lead to swelling of the eyes and vision loss. This can be a fatal condition, especially when not recognized right away, we pray we were in time.

I have been surprised at how well Paulus is doing. He can't open his eyes or see, but communicates with his parents about his needs. He complained of a lot of pain of his eyes, head, and neck, but this has gone down a big. His confusion seems to have resolved and he is able to follow commands. He has continued to have temps of 102, so, today, I found some Vancomycin to give him, along with all the other antibiotics that we have. Today, he was laying in bed eating a scone and his dad was giving him fanta which he drank from the bottle cap, when I rounded this am. His parents faithfully care for him and always greet me with a smile. I am not sure if he will recover fully from this, but am praying with his parents every morning that he does.