Fatal otitic hydrocephalus due to sinus thrombosis: A case report

Objective@#To report a case of chronic suppurative otitis media with complications of lateral sinus thrombosis and otitic hydrocephalus and to discuss its clinical manifestations, clinical course, ancillary procedures and management.@*Methods@#Study Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. @*Results@#A 35-year-old man was admitted due to intermittent right otorrhea for 20 years and headache for a month. The Glasgow Coma Scale (GCS) score was 12, and mastoidectomy performed on the second hospital day showed cholesteatoma with erosion of the bony covering of the sigmoid sinus with scanty purulent discharge. The GCS improved to 15 few hours post- operatively, however, 24 hours post-operatively, GCS decreased from 15 to 10 and a CT scan showed dilatation of cerebral ventricles and lateral sinus thrombosis which persisted on subsequent imaging studies. His condition deteriorated irreversibly despite a ventriculostomy, and he eventually expired after 3 weeks in the ward. @*Conclusion@#Otitic hydrocephalus due to lateral sinus thrombosis is a serious complication of chronic suppurative otitis media seldom encountered nowadays. In this case, otitic hydrocephalus developed and progressed despite broad spectrum antibiotics, mastoidectomy and a ventricular shunt. This case report underscores the importance of early recognition of warning signs of intracranial complications to institute prompt management.

Trombectomía mecánica mediante técnica de aspiración directa de primer paso en pacientes con ictus isquémico y trombosis del seno venoso / Mechanical thrombectomy by a direct aspiration first pass technique in patients with stroke and sinus venous thrombosis.

INTRODUCCIÓN. La enfermedad cerebrovascular ha sido una de las primeras causas de muerte y la principal causa de discapacidad a nivel mundial, que incluye a nuestro país. La utilidad y efectividad de la trombectomía mecánica es aceptada por la comunidad médica especializada y el no considerar en forma consistente este recurso a los pacientes candidatos para la misma ha constituido un retraso para nuestra práctica médica. Se relata la experiencia con pacientes de ictus isquémico y trombosis venosa de seno lateral. OBJETIVO. Reportar la experiencia de los resultados obtenidos en el tratamiento del ictus isquémico y trombosis venosa intracraneal mediante trombectomía mecánica por aspiración. MATERIALES Y MÉTO-DOS. Se presentó tres casos de pacientes con sintomatología neurológica relacionada a ictus isquémico y trombosis venosa cerebral, que fueron tratados mediante trombectomía mecánica entre diciembre del 2018 y Noviembre del 2019 mediante técnica de aspiración directa de primer paso. Se aplicó la Escala de Accidentes Cerebrovasculares del Instituto Nacional de Salud. RESULTADOS. La oclusión se produjo en territorio de arteria cerebral media y venoso superficial intracraneal. La recanalización fue satisfactoria en los tres casos, no presentaron complicaciones y con mejoría neurológica inmediata post procedimiento, sin secuelas. DISCUSIÓN. El ictus isquémico y la trombosis venosa son patologías de etiología múltiple dentro de las patologías vasculares neurológicas, de manera principal ateroscleróticas, cardioembólicas o condiciones protrombóticas, sin embargo al tratarse de eventos agudos requirió de la resolución inmediata mediante técnicas mecánicas neurointervencionistas, para evitar secuelas graves y permanentes e incluso el deceso del enfermo. CONCLUSIÓN. La utilización de modernas técnicas de neurointervencionismo, en especial la técnica de aspiración de primer paso, ha permitido dar mayor oportunidad de recuperación y so-brevida a quienes padecen de tromboembolias agudas en vasos cerebrales, tanto arteriales como venosas y se demostró por el nivel de evidencia que en manos entrenadas son la única alternativa de tratamiento en oclusión de vasos mayores.

INTRODUCTION. Cerebrovascular disease is one of the leading causes of death and the leading cause of disability worldwide, including our country. The usefulness and effectiveness of mechanical thrombectomy is accepted by the specialized medical community and the failure to consistently consider this resource to pa-tients who are candidates for it has constituted a delay in our medical practice. The experience with patients with ischemic stroke and lateral sinus venous thrombosis is reported. OBJECTIVE. Report the experience of the results obtained in the treatment of ischemic stroke and intracranial venous thrombosis by mecha-nical aspiration thrombectomy. MATERIALS AND METHODS. Three cases of patients with neurological symptoms related to ischemic stroke and cerebral venous thrombosis were presented, who were treated by mechanical thrombectomy between december 2018 and November 2019 using the first step direct aspira-tion technique. The Stroke Scale of the National Institute of Health was applied. RESULTS. The occlusion occurred in the territory of the middle cerebral artery and intracranial superficial venous. Recanalization was satisfactory in all three cases, there were no complications and immediate neurological improvement after the procedure, without sequelae. DISCUSSION. ischemic stroke and venous thrombosis are pathologies of multiple etiology within neurological vascular pathologies, mainly atherosclerotic, cardioembolic or prothrom-botic conditions, however, when dealing with acute events, they required immediate resolution by means of neurointerventional mechanical techniques, to avoid serious sequelae and permanent and even the death of the patient. CONCLUSION. The use of modern neurointerventional techniques, especially the first step aspiration technique, has given a greater chance of recovery and survival to those who suffer from acute thromboembolism in cerebral vessels, both arterial and venous, and it was demonstrated by the level of evidence that in trained hands they are the only treatment alternative for occlusion of major vessels.

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.

A Case of Epidural Abscess Complicated from Acute Mastoiditis Caused by Streptococcus pneumoniae / 소아감염

Acute otitis media (AOM) is one of the most common childhood infectious diseases. Despite antibiotic treatment for AOM, AOM and its complication still continue to develop. Acute mastoiditis is a serious complication of AOM and epidural abscess constitutes the commonest of all intracranial complication of AOM. Neurological complication of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We report the rare case of acute otitis media progressing to acute mastoiditis, epidural abscess formation and lateral sinus thrombophlebitis caused by Streptococcus pneumoniae in a child. She was admitted with acute otitis media with fever. Despite proper antibiotics, acute mastodititis and epidural abscess were developed, and after surgical drainage and antibiotics therapy she was recovered without sequalae.

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.

Isolated Lateral Sinus Thrombosis Presenting as Cerebellar Infarction in a Patient with Iron Deficiency Anemia

As a rare cerebrovascular disease, cerebral venous thrombosis (CVT) is caused by various conditions including trauma, infection, oral contraceptive, cancer and hematologic disorders. However, iron deficiency anemia is not a common cause for CVT in adult. Posterior fossa infarction following CVT is not well demonstrated because posterior fossa has abundant collateral vessels. Here, we report a case of a 55-year-old man who was admitted with complaints of headache, nausea, and mild dizziness. The patient was diagnosed with isolated lateral sinus thrombosis presenting as cerebellar infarction. Laboratory findings revealed normocytic normochromic anemia due to iron deficiency, and the patient's symptoms were improved after iron supplementation.

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.

Transverse sinus thrombosis associated with otitis media and mastoiditis

A case of transverse sinus thrombosis is described in an adolescent male with antecedent meningomyelocele corrected by surgery, and ventriclo-peritoneal derivation. Four months before the occurrence of thrombosis, he presented with bilateral otitis media and mastoiditis, and was treated with antibiotic. Magnetic resonance images were not obtained before referral to our hospital. The patient received full anticoagulation and his clinical course was uneventful. He remains asymptomatic under outpatient surveillance till this report. The aim of reporting the case is to emphasize the role of otologic infections in the origin of intracranial thrombotic phenomena, and highlights the findings of magnetic resonance venography for characterization of intracranial sinus thrombosis

Two Cases of Intracranial Complications Associated with Chronic Silent Otitis Media in Immune-Competent Adults / 대한이비인후과학회지

Chronic otitis media is defined as a condition associated with a perforation of the tympanic membrane with a history or existence of otorrhea. Chronic silent otitis media refers to chronic pathologic condition behind an intact tympanic membrane, which may be clinically undetected or undetectable. Because this chronic pathology is undetected, there is a lack of clinical treatment, which increases the risk of complications and sequelae. Otogenic intracranial complications in intact tympanic membrane are usually reported in pediatric patients with acute otitis media and are rare in immune-competent adult patients. We report two cases of immune-competent patients who suffered from intracranial complications of chronic silent otitis media, one leading to a lateral sinus thrombophlebitis and the other leading to meningitis.

Anticoagulation for cerebral venous thrombosis with subarachnoid hemorrhage: a case report

To report the success of anticoagulation [AC] treatment in a case of cerebral venous thrombosis [CVT] with subarachnoid hemorrhage [SAH] in view of the limited evidence seen in the literature supporting such a treatment option. A 38-year-old lady with CVT and SAH presented 12 h after the onset of symptoms. AC with low-molecular-weight heparin was started 4 days later, when the repeated brain CT showed regression of the SAH. Heparin was changed to warfarin, and she was asymptomatic over a 12-month follow-up period. In a limited number of small studies, AC has been found to be beneficial for cases of CVT with hemorrhagic complications. The proper time to start AC in such cases was not clearly defined, and a delay of 4-33 days was observed after the onset of symptoms. In cases of spontaneous intracranial hemorrhage [ICH] in general, active bleeding is usually confined to the first 6 h, and chances of hematoma enlargement are higher in the first 24 h. On the other hand, it has been advised to rule out a coincidental vascular malformation and to radiologically confirm regression [or at least non-progression] of the ICH before starting AC. AC for cases of CVT may remain beneficial in the presence of SAH. The time to start AC for CVT with hemorrhagic complications is unclear; however, AC was successful when given 4 days after the onset of symptoms in our case. It may be wise to repeat CT after at least 24 h from the onset of symptoms [to confirm regression or at least non-progression of the ICH] before starting AC. It may also be prudent to perform magnetic resonance angiography, or digital subtraction angiography to rule out a coincidental intracranial aneurysm before AC

Giant Arachnoid Granulation Misdiagnosed as Transverse Sinus Thrombosis

We experienced a case of giant arachnoid granulation misdiagnosed as dural sinus thrombosis. A 66-year-old woman presented with a one month history of progressive occipital headache. Computed tomography angiography and cerebral angiography showed a round filling defect at the transverse sinus which was speculated as a transverse sinus thrombosis. Anticoagulation therapy was performed to prevent worsening of thrombosis for 2 weeks and then a Gadolinium-enhanced magnetic resonance imaging scan was performed. The filling defect lesion at the transverse sinus revealed a non-enhancing granule with central linear enhancement, which was compatible with giant arachnoid granulation. We checked the intrasinus pressure difference across the lesion the through the dural sinus in order to exclude the lesion as the cause of headache. Normal venous pressure with no significant differential pressure across the lesion was noted. Headache was treated with medical therapy.

Trombosis de los senos venosos, complicación tardía post mastoiditis en una preescolar / Venous sinus thrombosis: A late complication of mastoiditis in preschoolar girl

Introducción: La trombosis del seno lateral (seno sigmoídeo) secundaria a mastoiditis aguda cada vez es más infrecuente en nuestro medio y aún más si se habla de lesiones más extensas que comprometan a otros senos como el transverso. Sin duda el diagnóstico precoz y el manejo adecuado de la otitis media aguda han influido de manera importante para que esto suceda. Lo habitual es que se trate de pacientes sépticos con una sintomatología otológica manifiesta y repercusión sistémica. Hoy día comenzamos a ver casos en que el cuadro clínico es muy poco llamativo y a veces el diagnóstico se realiza de manera casual en el transcurso de la cirugía matoídea. Caso: Presentamos una niña de 5 años con trombosis de los senos lateral y transverso que tuvo como presentación clínica un signo de focalización neurológica (diplopia) sin otro hallazgo otoscópico ni otorrinolaringológico de interés. Se empleó sólo tratamiento médico, tuvo una evolución favorable y lenta, pero quedó sin secuelas. Discusión: Revisamos la literatura y la comparamos con nuestra decisión terapéutica.

Cardiovascular involvement in Behcet's disease / 대한내과학회지

BACKGROUND: Behcet's disease (BD) is a systemic disease of unknown cause, belonging to vasculitis pathologically. There are only few reports describing the frequency and clinical features of cardiovascular involvement in BD, even though the vascular lesions involving artery and large-sized vein has been reported to be important in prognosis. We performed a retrospective study to address the clinical features of Behcet's disease involving cardiovascular system. METHODS: We studied 155 patients with BD who fulfilled the international criteria. The frequency and clinical characteristics of cardiovascular involvement were studied retrospectively. RESULTS: Among 155 patients with BD, 27 patients (17.4%) have cardiovascular involvement. When they were compared with patients without cardiovascular lesions, male proportion was significantly higher (OR 5.541, 95% CI 2.033~15.105, p=0.001) and the age at onset was younger (OR 1.059, 95% CI 1.003~1.118, p=0.037). Nine patients (5.8%) had arterial lesions which included 10 cases of arterial aneurysm and 3 cases of arterial occlusion. Arterial aneurysm occurred at aorta (3 cases) and pulmonary artery (3 cases) most frequently. Arterial occlusion occurred at coronary artery, brachial artery and digital artery. There were 4 patients with cardiac valvular lesions which included aortic regurgitation (3 cases) and tricuspid stenosis (1 case). Nineteen patients (12.3%) had venous lesions. Among them deep vein thrombosis were 25 cases, and transverse sinus thrombosis was one case. When the patients with deep vein thrombosis were divided by the site of the lesion, the cases involving deep femoral and popliteal vein were the most frequent (6 patients respectively), which were followed by iliac vein, superficial femoral vein, and superior vena cava. When the patients were divided into arterial and venous involvement groups, they showed no significant differences in clinical features. CONCLUSION: In BD patients, the frequency of cardiovascular involvement was 17.4% of which that of deep vein thrombosis was the highest. Arterial aneurysm was the most frequent among arterial lesions. The patients with cardiovascular involvement had significantly higher male proportion and younger onset age than the patients without cardiovascular lesions.

Anti-cardiolipin Antibody and Coagulopathy in a Patient with Kawasaki Disease Complicated by Meningitis / 대한소아혈액종양학회지

Antiphospholipid antibodies are a family of autoantibodies directed against certain phospholipids or phospholipid-binding proteins. Antiphospholipid antibody syndrome can occur as a secondary event to an underlying autoimmune disease, most commonly systemic lupus erythematosus and also occur in certain infectious diseases and drug reactions. We experienced a patient with Kawasaki disease who had anticardiolipin antibodies accompanied by coagulation abnormalities. A 4-month-old female patient was admitted due to fever, irritability, lymph node swelling on the right submandibular area and maculopapular skin rashes on trunk and both extremities. She had prolonged activated partial thromboplastin time (aPTT). Further investigations revealed a positive anticardiolipin antibody detected by ELISA. She had right lateral sinus thrombosis on parieto-occipital area on brain MRI and thrombotic microangiopathy, resulting in necrosis of toe. She showed considerable improvement in affected skin after dexamethasone treatment for 3 weeks. Thrombosis was resolved completely 2 months later.

A Case of Epidural Abscess Formation and Lateral Sinus Thrombophlebitis Complicating Chronic Otitis Media with Cholesteatoma / 대한이비인후과학회지

The incidence of intracranial complications of otitis media, including lateral sinus thrombophlebitis, has been significantly reduced since the advent of antibiotics. This entity is rarely encountered in clinical practice, and delay in its diagnosis and institution of appropriate therapy may lead to serious, or even fatal, consequences. The signs and clinical course of lateral sinus thrombophlebitis are non-specific and the final diagnosis rests upon radiological investigations including CT-scans and MRI. We have experienced a case of middle fossa and posterior fossa epidural abscess formation, lateral sinus thrombophlebitis that has developed secondary chronic otitis media with cholesteatoma in a 47 year-old female patient. We report this case which was successfully treated by middle fossa dura and posterior fossa dura drainage, lateral sinus thrombectomy with open mastoidectomy.