Subarachnoid haemorrhage associated with septic cavernous sinus thrombosis secondary to odontogenic maxillary sinusitis.

This case report describes a man in his 50 s who developed septic cavernous sinus thrombosis secondary to odontogenic maxillary sinusitis complicated by a non-aneurysmal subarachnoid haemorrhage (SAH). He presented with visual loss, altered consciousness and shock. CT revealed SAH near the left Sylvian fissure; right maxillary sinusitis and thrombosis of the cavernous sinuses, superior ophthalmic veins and internal jugular veins without an aneurysm. Despite intensive treatment, including broad-spectrum antibiotics, anticoagulants, tooth extraction and endoscopic sinus drainage, he developed a haemorrhagic venous infarction and subsequently died from cerebral herniation due to progressive brain swelling. Streptococcus dysgalactiae subsp. equisimilis (Group C Streptococcus) was isolated from both blood cultures and purulent material was aspirated during tooth extraction. This case highlights the pathogenic potential of Group C Streptococcus and the importance of recognising septic cerebral venous thrombosis as a cause of SAH.