• Pengchen He, Zongping Li, and Han Jiang.
• Department of Neurosurgery, Mianyang Central Hospital Affiliated to University of Electronic Science and Technology of China, Mianyang, China.
• Medicine (Baltimore). 2023 Nov 24; 102 (47): e36123e36123.

RationaleSeptic cavernous sinus thrombosis (SCST) is a rare infectious thrombophlebitic disease. The infection often arises from the tissues surrounding the cavernous sinus as well as the cavernous sinus drainage. Early symptoms of SCST include fever, headache, proptosis, ptosis, bulbar conjunctival edema, and limited eye movement. The complications include venous sinus thrombosis, intracerebral abscess, and subdural empyema. Aneurysmal subarachnoid hemorrhage combined with acute cerebral infarction has not been reported.Patient ConcernsA 46-year-old man presented with visual impairment in his right eye and intermittent headache for 2 months. Ten days later, the patient developed a sudden loss of consciousness, coma, cardiac arrest, and respiratory arrest. The patient eventually died.DiagnosesSCST, acute cerebral infarction, aneurysmal subarachnoid hemorrhage, anterior cerebral artery aneurysm.InterventionsAntiplatelet and lipid-lowering therapy, antibiotic treatment, emergency aneurysm clipping, and decompressive craniectomy.OutcomesThe patient underwent emergency aneurysm clipping and decompressive craniectomy, and postoperative head computed tomography showed a massive cerebral infarction in the right cerebral hemisphere. The patient eventually died.LessonsWe report a case of SCST mainly presenting as acute cerebral infarction and aneurysmal subarachnoid hemorrhage, with an acute onset and ultimately a poor prognosis. This complication is extremely rare and have not yet reported according existing literatures but can be life-threatening if not recognized and treated promptly. Early antibiotic administration and early sinus drainage may alter the patient's prognosis. By describing this unusual the case we hope to raise awareness of the need of early illness detection and treatment in order to avoid catastrophic consequences. It also exemplifies the mechanism of acute inflammatory disorders and aneurysm development.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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