Otogenic Lateral Sinus Thrombosis: A Review of Fifteen Patients and Changing Trends in the Management

Abstract Introduction Otogenic lateral sinus thrombosis is a rare intracranial complication of otitis media in the modern age of antibiotic treatment, but it is potentially a dangerous complication. Objectives The aim of this study is to focus on the various clinical presentations, management options and sequelae in a series of fifteen patients with otogenic lateral sinus thrombosis. Methods Retrospective chart review of inpatients treated for otogenic lateral sinus thrombosis at our tertiary care institution between 2010 and 2015. Results A total of 15 patients (11 males and 4 females) with ages ranging from 9 to 60 years were diagnosed with otogenic lateral sinus thrombosis. The most commonly reported symptoms were headache, ear discharge and hard of hearing, which were experienced by all 15 (100%) patients. In contrast to previous studies found in the literature, 7 (47%) patients in our series presented with neck pain and neck abscess. Imaging studies and microbiological cultures were performed for all patients, who also underwent a mastoidectomy procedure. Internal jugular vein ligation was performed on 5 (33%) patients. Incision and drainage of the neck abscess was performed on 7 (47%) patients. All patients had a satisfactory resolution of their symptoms, and the mortality rate was of 0%. Conclusions Otogenic lateral sinus thrombosis, though a rare complication, can still occur; therefore, keeping a high level of suspicion is important, especially in developing countries. We also describe the patients with neck abscess associated with this rare condition. Combining parenteral antibiotics with surgical intervention is the treatment of choice.

Intracranial Complications of Chronic Suppurative Otitis Media with Cholesteatoma – A Retrospective Study

Background: Chronic suppurative otitis media is a common problem in our part of the world and few end up with intracranial complication. Brain abscess, meningitis and lateral sinus thrombosis are the most common intracranial complications. Emergency Multi-specialty Intervention can prevent mortality. Aim: The objective of the study is to determine various types of intracranial complications affecting adult population with of Chronic Suppurative Otitis Media with Cholesteatoma in our institution. Methods: All admitted cases of intracranial complications due to chronic suppurative otitis media with cholesteatoma of any age and gender were included. Results: The most common age group was between 11 and 20 years and males were 80% more affected than females. And 90% of patients presented with unilateral disease of ear and 73% of cases had attic pathology. Incidence of intracranial complication in patients with CSOM with cholesteatoma was 1%. The most common complication was brain abscess (20%) followed by meningitis (20%), lateral sinus thrombosis (13.3%) and extradural abscess (16%). Conclusion: Brain abscess is the commonest intracranial complication of chronic suppurative otitis media with cholesteatoma followed by Meningitis. Early surgical intervention in combination with broad spectrum antibiotics provides a good outcome.

Trombosis venosa cerebral en una paciente puérpera con preeclampsia con datos de severidad / Cerebral venous thrombosis in a post-partum patient with preeclampsia with signs of severity

Resumen ANTECEDENTES: la trombosis venosa cerebral es infrecuente, pero con mayor incidencia durante la gestación y el puerperio. OBJETIVO: revisar la bibliografía más reciente y proponer una opción de tratamiento de la paciente con trombosis venosa cerebral durante el puerperio. CASO CLÍNICO: paciente de 30 años de edad, con antecedente de dos embarazos y dos cesáreas. En el séptimo día de puerperio tuvo edema de miembros inferiores, cifras tensionales elevadas, cefalea y alteraciones visuales. Con el tratamiento antihipertensivo con nifedipino y neuroprotección con sulfato de magnesio se logró el control de la hipertensión, aunque persistieron la cefalea y los síntomas de visión borrosa y diplopía. La resonancia magnética reportó: trombosis venosa de seno transverso lateral izquierdo. Con el tratamiento anticoagulante hubo disminución importante de los síntomas neurológicos. CONCLUSIONES: puesto que la preeclampsia y la eclampsia pueden ocultar los síntomas de la trombosis venosa cerebral, es importante tener siempre en mente ambos padecimientos para el diagnóstico y tratamiento oportuno de uno y otro.

Abstract BACKGROUND: cerebral venous thrombosis is infrequent, but with the highest incidence during pregnancy and puerperium. OBJECTIVE: to review the most recent bibliography and propose a treatment option for the patient with cerebral venous thrombosis during puerperium. CLINICAL CASE: a 30 year old patient with a history of two pregnancies and two Cesarean sections. On the seventh day of puerperium she presented edema of the lower limbs, high blood pressure, headache and visual disorders. Antihypertensive treatment with nifedipine and neuroprotection with magnesium sulfate, hypertension was controlled although the headache and blurry vision and double vision symptoms persisted. The MRI results reported: venous thrombosis of the left lateral transverse sinus. With anticoagulant treatment there was significant decrease of neurological symptoms. CONCLUSIONS: since preeclampsia and eclampsia can hide symptoms of cerebral venous thrombosis, it is important to always consider both conditions for the timely diagnosis and treatment of both.

Hidrocéfalo ótico secundario a trombosis del seno lateral en niños: reporte de un caso clínico y revisión de la literatura / Otitic hydrocephalus secondary to lateral sinus thrombosis in children: a case report and literature review

La trombosis del seno lateral es una complicación potencialmente mortal de la otitis media aguda, aunque infrecuente en la actualidad debido al amplio uso de antibióticos. Sus manifestaciones clínicas son habitualmente fiebre, cefalea y otalgia, agregándose vómitos, edema de papila y compromiso del estado general. El examen diagnóstico de elección es la resonancia magnética en fase venosa y el manejo incluye terapia antibiótica endovenosa, miringotomía con instalación de tubo de ventilación y mastoidectomía, asociado o no a anticoagulación. Se reporta el caso de un escolar de 9 años derivado al Hospital Carlos Van Buren con un hidrocéfalo ótico secundario a una trombosis del seno lateral, manejado con terapia antibiótica endovenosa, mastoidectomía simple, miringotomía con instalación de tubos de ventilación y anticoagulación, evolucionando favorablemente con regresión de la sintomatología y recanalización del seno en el control imagenológico. Se realiza una revisión bibliográfica sobre la presentación clínica, diagnóstico y manejo de la trombosis del seno lateral en niños como complicación de la otitis media aguda.

Lateral sinus thrombosis (LST) is a potentially life threatening complication of acute otitis media. However, report rates have been decreasing since the spreaded use of antibiotic prescription. Patient developing LST usually complain about fever, headache and ear pain. Consequently, they may develop vomiting, papilledema and unhealthy-ness. Magnetic resonance venography (MRV) is considered the gold standard for LST diagnosis. Management procedures include parenteral antibiotics, myringotomy with tympanostomy tube and mastoidectomy, associated or not with anticoagulant therapy. The present study reports the case of a 9-year-old male referred to the Hospital Carlos Van Buren diagnosed with an otitic hydrocephalus secondary to lateral sinus thrombosis, managed with intravenous antibiotic therapy, simple mastoidectomy, myringotomy with tympanostomy tube placement and anticoagulation. Favorable clinical and imagenologic outcomes were obtained. We provide a brief summary about clinical features, diagnosis and management of the LST in children as a complication of acute otitis media.

Gradenigo's Syndrome Complicated by Brain Abscess and Lateral Sinus Thrombosis due to Otitis Media

No abstract available.

Gradenigo's Syndrome Complicated by Brain Abscess and Lateral Sinus Thrombosis due to Otitis Media

No abstract available.

Trombosis de seno lateral como complicación de otitis media aguda en niños: Reporte de un caso y revisión de la literatura / Lateral sinus thrombosis as a complication of acute otitis media in children: A case report and literature review

La otitis media aguda es frecuente en niños y generalmente de evolución benigna. Durante las últimas décadas, con el uso de antibióticos y tratamientos quirúrgicos asociados, la incidencia de las complicaciones de la otitis media aguda ha disminuido hasta 10 veces junto con la mortalidad de éstas (menor al 10%). Las complicaciones se pueden clasificar según su localización en intratemporales o intracraneales. Dentro de las complicaciones intracraneales más frecuentes, se encuentra la trombosis del seno lateral. En el presente estudio se reporta el caso de un preescolar de 5 años que fue derivado al Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau por otitis media aguda complicada con mastoiditis y absceso subperióstico que fue drenado junto con una mastoidectomía. Cuatro días posterior a la cirugía se agrega cefalea, vómitos no explosivos y edema de papila por lo que se realiza una resonancia nuclear magnética en fase venosa que muestra trombosis del seno lateral. Se realiza una revisión de la literatura sobre el manejo de la trombosis del seno lateral y, basado en la evidencia existente, se propone un algoritmo de manejo para esta patología ya que aún no existe un consenso para su tratamiento.

Acute otitis media is a common disease in children and generally has a benign course. During recent decades, the use of antibiotics and associated surgical treatments has decreased the incidence of the complications of acute otitis media in 10 times, as well as the mortality which currently is less than 10%. According to their location, the complications can be classified in intratemporal or intracranial. Lateral sinus thrombosis is one of the most common intracranial complications of acute otitis media. The present study reports the case of a 5 year old child who was referred to our Department of Otolaryngology for acute otitis media complicated with mastoiditis and subperiosteal abscess. He underwent a mastoidectomy and the abscess was drained. Four days after surgery the child presented headache, nonexplosive vomiting and papilledema. Lateral sinus thrombosis was identified by magnetic resonance venography. We present a literature review on the management of this pathology, and, based on existing evidence, we propose an algorithm for the management of this condition because there is still no consensus for its treatment.

A Case of Primary Tuberculous Otitis Media with Lateral SinusThrombosis and Subperiosteal Abscess / 대한이비인후과학회지

Tuberculosis of the middle ear is a disease rarely encountered in recent years. Because what used to be the typical clinical signs of this disease have been changed in recent years and the index of suspicion being low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media complicated with lateral sinus thrombosis and subperiosteal abscess is reported with review of the literature, emphasizing the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.