BACKGROUND Infections are a common cause of childhood stroke with variable presentation. The current case describes a rare infective cause of venous and arterial stroke in an immunocompetent girl with management implications. CASE DESCRIPTION A 12 year old girl, presented with history of fever for 10 days, painful swelling of right eye for 7 days and altered sensorium for 2 days. On examination, she had right eye orbital cellulitis and fullness of right paranasal area. On nervous system examination, she was delirious, had right eye ophthalmoparesis, left upper motor neuron facial palsy and signs of meningeal inflammation. Her contrast enhanced CT head and subsequent MRI brain with arteriography and venography revealed right cavernous sinus and distal internal carotid artery thrombosis. She was started on intravenous ceftriaxone and vancomycin and subcutaneous heparin. In view of persistent symptoms, endoscopic debridement of right nasal cavity was done, which showed growth of aspergillus flavus. Subsequently, she was started on intravenous voriconazole. Within a week, she was afebrile, her inflammatory and neurological signs started improving. She was discharged after 3 weeks of intravenous voriconazole which was continued for 3 more weeks orally. Her procoagulant and immunodeficiency work up were normal. At 4 months follow up, she showed both clinical and radiological resolution. CONCLUSIONS Despite high mortality described in sino-orbital aspergillosis, early and appropriate treatment led to optimal outcome. In deep seated infections, isolation of etiological organism should be attempted, particularly when patient doesn't respond to conventional antimicrobial therapy.

中文翻译：

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免疫正常儿童中风的罕见感染原因

背景 感染是儿童中风的常见原因，具有不同的表现。当前病例描述了一名免疫功能正常的女孩发生静脉和动脉中风的罕见感染原因，具有管理意义。病例描述 一名 12 岁女孩，因发热 10 天，右眼肿痛 7 天，感觉异常 2 天就诊。检查时，她患有右眼眶蜂窝织炎和右鼻旁区域充盈。在神经系统检查中，她神志不清，右眼眼肌麻痹，左上运动神经元面瘫和脑膜炎症迹象。她的增强 CT 头部和随后的 MRI 脑动脉造影和静脉造影显示右侧海绵窦和远端颈内动脉血栓形成。她开始静脉注射头孢曲松和万古霉素以及皮下注射肝素。鉴于症状持续，行右鼻腔内镜清创术，可见黄曲霉生长。随后，她开始静脉注射伏立康唑。一周内，她不发热，炎症和神经系统症状开始好转。她在静脉注射伏立康唑 3 周后出院，并继续口服 3 周。她的促凝和免疫缺陷检查正常。在 4 个月的随访中，她显示出临床和放射学解决方案。结论 尽管在眶内曲霉病中描述了高死亡率，但早期和适当的治疗导致最佳结果。在深部感染中，应尝试分离病原体，特别是当患者不