Publication

Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves

Journal Paper/Review - May 23, 2013

Units
PubMed
Doi

Citation
Gutzeit A, Karrer U, Winkler K, Rodic B, Kos S, Hergan K, Gassmann K, Claas L, Reischauer C, Portocarrero Vivero-Fäh B, Roos J, Sartoretti-Schefer S. Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves. Korean J Ophthalmol 2013; 27:219-23.
Type
Journal Paper/Review (English)
Journal
Korean J Ophthalmol 2013; 27
Publication Date
May 23, 2013
Issn Print
1011-8942
Pages
219-23
Brief description/objective

Lemierre's syndrome is characterized by anaerobic septicemia, internal jugular vein thrombosis, and septic emboli associated with infections of the head and neck. We describe an unusual and clinically confusing case of a young woman with an acute paresis of the abducens nerve and partial paresis of the right oculomotor nerve. After an extensive imaging diagnostic procedure, we also documented a peritonsillar abscess and various types of thromboses in intracranial and extracranial veins. Furthermore, we found brain and lung abscesses, which led us to establish the diagnosis of Lemierre's syndrome. Despite intensive anti-coagulation and antibiotic therapy, the patient developed a mycotic aneurysm in the right internal carotid artery directly adjacent to the previously thrombosed cavernous sinus. In summary, we were able to confirm that Lemierre's syndrome may occur in conjunction with uncharacteristic symptoms. Due to the sometimes confusing clinical symptoms as well as clinical and radiological specialties, we had to work on an interdisciplinary basis to minimize the delay prior to establishing the diagnosis and therapy.