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Background: Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease that typically affects young females. Objectives: To describe the clinical, laboratory, and neuroimaging characteristics of CVST and evaluate the differences in characteristics of patients with unfavorable versus favorable outcomes. Methods: This retrospective study (2007 - 2018) reviewed all consecutive patients with CVST, assessing their demographic, clinical, laboratory, neuroimaging characteristics, and clinical outcomes. The modified Rankin Scale (mRS) was used to assess the functional outcomes of patients after a three-month follow-up. Factors affecting patients' outcomes (favorable [mRS ≤ 2] vs. unfavorable [mRS > 2]) were examined using the Independent t -test and chi-squared test. Results: A total of 141 patients (mean age: 38.15 ± 13.71; female-to-male ratio of 2.28) with CVST were included. Most of the admissions (42.6%) were in the summer. Most patients had a subacute disease onset (66.0%), with headaches being the most frequent manifestation (66.0%). Regular oral contraceptive pill use and fasting were the most frequent clinical risk factors (52.0% and 22.7%, respectively). Different types of inherited thrombophilia (deficiency in protein C, protein S, or antithrombin III) were recorded in nearly 13 to 16% of patients. The lateral transverse sinus (61.7%) and the superior sagittal sinus (45.4%) were the most frequently involved. The mortality rates at discharge and after three months were 4.3% and 8.0%, respectively. In the follow-up assessment, 81.3% of patients showed a favorable outcome [mRS ≤ 2], while 18.7% had an unfavorable outcome. Patients with unfavorable outcomes were significantly older compared to those with favorable outcomes (52 ± 5.81 vs. 35.95 ± 1.42, P = 0.017). Significant associations were observed between admission season (P = 0.020), chief complaint (P = 0.028), course of the disease (P = 0.021), previous thromboembolic events (P = 0.001), and antiphospholipid IgG (P = 0.032). Conclusions: The most prevalent risk factors among patients with CVST were being female, a history of using oral contraceptives, and fasting. Older patients with reduced consciousness, an acute disease course, a history of thromboembolic events, and positive antiphospholipid IgG are more likely to have an unfavorable outcome. [ABSTRACT FROM AUTHOR]

Otitic Hydrocephalus (OH) is one of the most significant life-threatening complications of otological infections. Given their low prevalence and non-specific ear symptoms, this complication requires a high index of suspicion for diagnosis. In this case report, we aim to provide an analysis of OH and describe common clinical signs and symptoms, treatment options, morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Working adults in high-altitude regions (HARs) are at higher risk of developing cerebral venous thrombosis (CVT) due to multiple factors. The clinico-radiological patterns pertaining to the high altitude associated with CVT can be different compared to those without HAR exposure. Objective: We aimed to study the clinico-radiological patterns of CVT in adult males diagnosed with CVT while working in mountainous regions at an altitude higher than 8000 feet above sea level. Methodology: The study population consists of adult males aged >18 years who suffered symptomatic CVT while working in mountains at high altitudes. They were divided into groups according to the altitude at which they were working as high-altitude (8202–11,483 ft), very high-altitude (11,484–19,029 ft), and extremely high-altitude (above 19,030 ft) regions. Meticulous history, clinical examination, imaging with computed tomography, magnetic resonance imaging, and laboratory investigations including procoagulation profile were done. The outcome was classified according to the modified Rankin score at 3-month follow-up. Results: Among the forty patients with CVT, 100% had a headache, 65% had vomiting, and 20% suffered convulsions at presentation. Increasing altitude was associated with higher clot load, increasing extent of involvement within the venous sinuses, and a tendency to involve deep veins in isolation or conjunction with the sinuses. Twenty-three recovered without any deficit and 15 were symptomatic without disability at the 3-month follow-up. Conclusion: In patients of CVT who are exposed to high altitudes in mountains, the increasing altitude is associated with higher clot load, increasing extent of involvement within the venous sinuses, and a tendency to involve deep veins. Polycythemia, smoking, alcohol, and deficiency of protein C are the coexisting factors.

(1) Background: Cerebral venous and dural sinus thrombosis (CVT) rarely appears in the adult population. It is difficult to diagnosis because of its variable clinical presentation and the overlapping signal intensities of thrombosis and venous flow on conventional MR images and MR venograms. (2) Case presentation: A 41-year-old male patient presented with an acute isolated intracranial hypertension syndrome. The diagnosis of acute thrombosis of the left lateral sinus (both transverse and sigmoid portions), the torcular Herophili, and the bulb of the left internal jugular vein was established by neuroimaging data from head-computed tomography, magnetic resonance imaging (including Contrast-enhanced 3D T1-MPRAGE sequence), and magnetic resonance venography (2D-TOF MR venography). We detected different risk factors (polycythemia vera-PV with JAK2 V617F mutation and inherited low-risk thrombophilia). He was successfully treated with low-molecular-weight heparin, followed by oral anticoagulation. (3) Conclusions: In the case of our patient, polycythemia vera represented a predisposing risk factor for CVT, and the identification of JAK2 V617F mutation was mandatory for the etiology of the disease. Contrast-enhanced 3D T1-MPRAGE sequence proved superior to 2D-TOF MR venography and to conventional SE MR imaging in the diagnosis of acute intracranial dural sinus thrombosis. [ABSTRACT FROM AUTHOR]

Introduction: Lateral sinus thrombosis (LST), a life-threatening complication of otitis media.The tender and edematous swelling or abscess at the area of exit of the emissary vein behind the mastoid process known as Griesinger’s sign is a pathognomonic sign for lateral sinus thrombosis. The subperiosteal abscess as a feature of Griesinger's sign may be a very rare presentation. Case Presentation: We report a case of 14 -year- old female presented with right sided cholesteatoma with lateral sinus thrombosis with meningitis with Griesinger's sign. Contrast-enhanced T1-weighted Magnetic Resonance Imaging (MRI) shows thrombosis of right lateral sinus, abscess in the postauricular region at the exit of mastoid emissary vein, and patent mastoid emissary vein connecting the lateral sinus and abscess. Discussion: Griesinger’s sign usually results from reflex thrombosis of the mastoid emissary vein in lateral sinus thrombosis. It may rarely manifest with direct venous spread of infection with subperiosteal abscess in the post-auricular region. Contrast-enhanced MRI can help differentiate the edematous swelling or abscess presentation of Griesinger’s sign in lateral sinus thrombosis and its possible pathogenesis.

Introduction: The aim of the study was to examine the role of the contrast-enhanced gadolinium-enhanced three-dimensional magnetic resonance venography (GE 3D MRV) technique in the detection of dural sinus pathologies by comparing the two-dimensional (2D TOF MRV). Methods: One hundred and eighty patients who underwent MRV due to dural sinus pathology in the radiology department of Haydarpaşa Numune Training and Research Hospital between January 2019 and July 2019 were included in the study. Images of 21 patients in the study group who had both 2D TOF MRV or GE 3D MRV were evaluated retrospectively. Results: About 33.3% of cases were male and 66.7% (n=14) were female. The mean age of the patients was 29.7±4.64 years (18-64 years). In 2D TOF MRV series, complete signal loss was observed in the unilateral transverse sinus (TS) of four patients (2.2%/180-1.6%) and in the sinus rectus of 1 patient (1/180-0.55%). Of these, 2 (1.1%) located in the TS and GE (2.1%) located in the sinus rectus were confirmed in the 3D MRV. Two patients' imaging showed a jugular vein and ipsilateral sigmoid sinus flow defect on 2D TOF MRV, but no findings on GE 3D MRV. There were four arachnoid granulations observed in the transverse sinuses in 4% of cases on two-dimensional venography, all of them confirmed on contrast-enhanced examinations. Six of the flow gaps observed in the transverse sinuses of 12 patients in 2D TOF MRV, disappeared completely in GE 3D MRV. When the diameters of the transverse sinuses were determined using the two techniques, the ratio of inconsistencies in Grade 0 and Grade 3 was higher than the others. Discussion and Conclusion: GE 3D MRV, a contrast imaging method, can be used effectively when there is a diagnostic challenge to exclude sinus thrombosis on 2D TOF imaging. [ABSTRACT FROM AUTHOR]

We wanted to present this case to emphasize that the diagnosis of complicated otitis media should be kept in mind in patients presenting to the emergency department with headaches, nausea, vomiting, and confusion. Our case was a 30-year-old male patient. Although he was on oral treatment for otitis media, his symptoms persisted, and a headache started. A brain CT scan performed in the emergency room revealed no pathology. Five days later, pneumocephalus and surrounding subarachnoid hemorrhage were detected on brain CT imaging due to nausea, vomiting, headache, and confusion. The patient was discharged 70 days after receiving medical care. As seen in our case, it should be kept in mind that pneumocephalus in an unconscious patient may occur due to nontraumatic causes and may be a consequence of complicated otitis media, and this situation should be thoroughly investigated. [ABSTRACT FROM AUTHOR]

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.

(1) Background: Cerebral venous and dural sinus thrombosis (CVT) rarely appears in the adult population. It is difficult to diagnosis because of its variable clinical presentation and the overlapping signal intensities of thrombosis and venous flow on conventional MR images and MR venograms. (2) Case presentation: A 41-year-old male patient presented with an acute isolated intracranial hypertension syndrome. The diagnosis of acute thrombosis of the left lateral sinus (both transverse and sigmoid portions), the torcular Herophili, and the bulb of the left internal jugular vein was established by neuroimaging data from head-computed tomography, magnetic resonance imaging (including Contrast-enhanced 3D T1-MPRAGE sequence), and magnetic resonance venography (2D-TOF MR venography). We detected different risk factors (polycythemia vera-PV with JAK2 V617F mutation and inherited low-risk thrombophilia). He was successfully treated with low-molecular-weight heparin, followed by oral anticoagulation. (3) Conclusions: In the case of our patient, polycythemia vera represented a predisposing risk factor for CVT, and the identification of JAK2 V617F mutation was mandatory for the etiology of the disease. Contrast-enhanced 3D T1-MPRAGE sequence proved superior to 2D-TOF MR venography and to conventional SE MR imaging in the diagnosis of acute intracranial dural sinus thrombosis.

Otogenic lateral sinus thrombosis (LST) occurs as an intracranial complication of otitis media. In the preantibiotic era, the mortality was almost 100%. Today, thanks to antibiotics, the rate of mortality dropped at 10%. In the context of chronic otitis media, the infection migrates through bone dehiscence or erosions and causes initially an abscess around the lateral sinus, with thrombophlebitis of the venules that surround the external wall of the sinus in the proximity to dura mater, and these will lead to necrosis of the sinus wall, determining the adhesion of fibrin and platelets and, finally, forming a mural thrombus, which evolves towards superinfection and sinus occlusion. Parts of the infected thrombus will break off and enter the blood stream, with all the general symptoms and the possible complications from it. We present and discuss a case of lateral sinus thrombosis following chronic otitis media in the pandemic context. The particularity of the case is given by the COVID-19 restrictions. In the absence of the antibiotic therapy, due to the pandemic circumstances, the child developed a typical form of LST. Knowledge of the clinical manifestations of “classic” lateral sinus thrombosis facilitated the diagnostic process. Fortunately, today our patient was able to benefit from powerful broad-spectrum antibiotics which, combined with the surgical treatment, saved his life. [ABSTRACT FROM AUTHOR]

Cerebral venous thrombosis (CVT), a rare but potentially severe cerebrovascular disease, is defined as the thrombosis of a cortical or deep cerebral vein, or a cerebral venous sinus. This article reports 2 cases of CVT. In the first case, the patient is a 40-year-old woman with a history of 2 miscarriages, using oral contraception and presenting intense headache, cervical irradiation, and drowsiness. The second case reports a 43-year-old woman with a history of Crohn disease and daily use of oral contraception, presenting headache, neck pain, and hypersensitivity to noise and light. Noncontrast CT, CT venography, magnetic resonance imaging (MRI) and MR venography (MRV), first-line noninvasive diagnostic modalities in clinical practice, led us to the diagnosis of CVT: hypoplastic lateral sinus CVT in the first case and deep cerebral vein CVT complicated by hemorrhagic infarction in the second case. The early diagnosis of CVT is extremely important, but often a challenge due to highly variable clinical presentation and radiographic findings. MRI and the MRV play a crucial role in case of anatomical variant and in better assessing the extension of thrombus, as well as parenchyma involvement and complications.

Background: Dural venous sinus injury is a rare complication of otological surgery that can lead to life-threatening sequelae, the management of which is complex and poorly described. Case report: This paper describes the case of a 40-year-old female who underwent routine right myringoplasty complicated by sigmoid sinus laceration. The patient subsequently developed right-sided lateral sinus thrombosis leading to fulminant intracranial hypertension. The patient underwent successful emergency management by surgical reconstruction of the sigmoid sinus, followed by endovascular thrombolysis, catheter balloon angioplasty and endovascular stenting. Conclusion: Torrential haemorrhage following otological procedures is uncommon and rarely requires packing of a bleeding venous sinus. This case highlights that injury to a highly dominant venous sinus can lead to venous outflow obstruction and life-threatening intracranial hypertension. To our knowledge, the development of this complication following otological surgery and its management has not been reported previously. [ABSTRACT FROM AUTHOR]

Extra‐ and intracranial complications of cholesteatoma are rare in the new era of antibiotics. The rarity of the severe complications and the atypical symptoms cause difficulties to set up proper diagnosis and treatment. We report about a 76‐year old patient with external auditory canal cholesteatoma causing Bezold abscess and sigmoid sinus thrombosis. The patient underwent canal wall up mastoidectomy and mastoid obliteration with abdominal fat and Bezold abscess drainage. Systemic antibiotic and anticoagulant therapy were applied. The treatment resulted in fast improvement in the general condition of the patient, and the control magnetic resonance imaging (MRI) showed no recurrence of the disease. Laryngoscope, 131:E1282–E1285, 2021 [ABSTRACT FROM AUTHOR]

Objective  The role of anticoagulation (AC) in the management of otogenic cerebral venous sinus thrombosis (OCVST) remains controversial. Our study aims to better define when AC is used in OCVST. Methods  MEDLINE, EMBASE, and The Cochrane Library were searched from inception to February 14, 2019 for English and English-translated articles. References cited in publications meeting search criteria were searched. Titles and abstracts were screened and identified in the literature search, assessing baseline risk of bias on extracted data with the methodological index for nonrandomized studies (MINORS) scale. Random effects meta-regression followed by random forest machine learning analysis across 16 moderator variables between AC and nonanticoagulated (NAC) cohorts was conducted. Results  A total of 92% of treated patients were free of neurologic symptoms at the last follow-up (mean 29.64 months). Four percent of AC and 14% of NAC patients remained symptomatic (mean 18.72 and 47.10 months). 3.5% of AC patients experienced postoperative wound hematomas. AC and NAC recanalization rates were 81% (34/42) and 63% (five-eights), respectively. OCVST was correlated with cholesteatoma and intracranial abscess. Among the analyzed covariates, intracranial abscess was most predictive of AC and cholesteatoma was most predictive of NAC. Comorbid intracranial abscess and cholesteatoma were predictive of AC. Conclusion  The present study is the first to utilize machine learning algorithms in approaching OCVST. Our findings support the therapeutic use of AC in the management of OCVST when complicated by thrombophilia, intracranial abscess, and cholesteatoma. Patients with intracranial abscess and cholesteatoma may benefit from AC and surgery. Patients with cholesteatoma can be managed with NAC and surgery. [ABSTRACT FROM AUTHOR]

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.

Objective: In children, lateral sinus thrombosis (LST) following minor head injury (MHI) has occasionally been reported because of neuroimaging techniques. However, the condition is rare, and its pathophysiology remains unknown. We aimed to identify the factors associated with its etiology and severity to provide information to guide the diagnosis, management, and prognosis. Methods: We retrospectively reviewed all patients aged 1–15 years with craniofacial trauma presenting to our emergency department between 2011 and 2015. In total, 4 patients with LST following MHI were identified. We also performed a comprehensive literature review to identify relevant cases in studies published between 1990 and 2015, and this yielded 17 studies with 24 patients. We analyzed the data for these 24 patients with our 4 cases (n = 28). Results: The mean age of the 28 cases was 7.0 years, and the male-to-female ratio was 1.2:1. Nausea/vomiting and headache were the most common symptoms, but signs and symptoms of increased intracranial pressure were present in 5 patients. The sigmoid sinus was most commonly affected. A total of 20 patients were treated conservatively, and the remaining 8 patients received anticoagulation. All patients had good outcomes, with no major complications. Radiological follow up showed complete recanalization in 14 patients and partial recanalization in 3 patients. Conclusions: Although LST following MHI is still rare in children, our findings indicate that it might be much more common than previously thought. Thankfully, though, most patients appear to have an excellent prognosis. A high degree of suspicion should be maintained when assessing patients with MHI, because the non-specific symptoms make diagnosis difficult. Neuroimaging by magnetic resonance venography or computed tomography venography is crucial for both diagnosis and follow up. Hypercoagulation disorders should be excluded, and anticoagulation therapy should be given to patients with these disorders, or to those with persistent or progressive LST. Conservative therapy is recommended, although anti-edema drugs or intermittent lumbar puncture may be beneficial.

Competing Interests: The authors report no conflicts of interest.

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. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of intracranial complications among the patients of chronic suppurative otitis media presenting at tertiary care hospital, Karachi. Study design: Descriptive cross-sectional study. Place and duration: Department of Ear, Nose, Throat and Head and Neck Surgery, Jinnah Post-Graduate Medical Centre, Karachi from July 2013 till January 2014. Material and methods: A total of 177 patient of either sex (aged 18 to 50 years) who gave informed consent, having ear discharge for 6-12 weeks, perforated tympanic membrane confirmed by otoscopic examination were included. The approval was taken from the research and ethical committee of JPMC, Karachi. Data was collected on predesigned proforma, CT scan temporal bone was done to confirm the diagnosis. SPSS version 20 was used for statistical analysis. Descriptive analysis was done for all demo-graphic variables. The frequency of intracranial complications in chronic suppurative otitis media was determined and Chi square test. P-value <0.05 was considered significant. Results: The mean age of the patients were 30.1± 9.3 years and mean duration of disease were 9.4±2.89 weeks. Male patients were (54.8%) whereas (45.2%) were female. Frequency of intra-cranial complications shows that meningitis was found in (21.5%), lateral sinus thrombosis in (4.5%) and Otitic hydro-cephalus was found in (2.8%) patients. Statistically signifiicant (P<0.05) difference was found between presence of meningitis with gender and duration of disease. Conclusion: Common intra-cranial complications among the patients of chronic suppurative otitis media were meningitis, lateral sinus thrombosis and otitic hydro-cephalus based on the study carried out at Jinnah Post-Graduate Medical Centre, Karachi. [ABSTRACT FROM AUTHOR]

Background: Hypoplasia of the transverse sinus (TS) is a common anatomical variation. However, the relationship between TS hypoplasia and venous thrombosis has not been studied. We analyzed the hypothesis that TS hypoplasia is a predisposing factor for ipsilateral thrombosis.Materials and Methods: We retrospectively evaluated 20 confirmed cases with isolated TS thrombosis and 43 age- and sex-matched controls. TS thrombosis and hypoplasia were diagnosed using both computed tomography and magnetic resonance venography. Hypoplasia was defined as a TS diameter less than 50% of the cross-sectional diameter of the lumen of the distal superior sagittal sinus and by a bony groove ratio less than 1.02. Univariate analysis was performed to evaluate the association between TS hypoplasia and thrombosis.Results: There were a total of 45 hypoplastic TS: 31 (49%) left hypoplastic TS (12 (60%) cases vs 19 (44%) controls (P = .24), and 14 (22%) right hypoplastic TS (9 (45%) cases vs 5 (12%) controls (P = .003). TS hypoplasia was more frequently found in cases (n = 18, 90.0%) than in controls (n = 22, 51.2%; relative risk 1.7, confidence interval [CI] 95% 1.3-2.4, P = .003). Hypoplastic TS and ipsilateral TS thrombosis showed a significant association (P = .002 for right and P = .008 for left TS hypoplasia) with relative risk of 3.8 (95% CI 1.3-10) for right and 7.5 (95% CI 1.1-48) for left hypoplasia. No significant association was found between hypoplastic TS and functional outcome at 30- or 90-day follow-up.Conclusion: TS hypoplasia might be a predisposing factor for ipsilateral TS thrombosis, but not for functional outcome. [ABSTRACT FROM AUTHOR]

Background Intracranial complications (ICC) of chronic suppurative otitis media (CSOM) occur even in the antibiotic area. These complications are commonly seen in pediatric patients due to poor hygiene and low immunity. They are more prevalent in developing countries due to illiteracy, low socioeconomic status and lack of access to health care facilities. Objective To study the incidence, clinical profile, treatment and outcome of pediatric patients presenting with intracranial complications of chronic suppurative otitis media. Methods A retrospective analysis of intracranial complications of CSOM in pediatric patients was conducted over a period of 15 years at a tertiary level institute. Data regarding age, sex, clinical presentation, laboratory and radiological investigations, management, duration of hospitalization, and outcomes were recorded. Results There were 142 patients, in the pediatric age group, diagnosed as having intracranial complications due to chronic otitis media during the study period. There was a decline in the incidence of ICC of CSOM. The most frequent intracranial complication seen was brain abscess (58.5%). All patients were administered intravenous antibiotics for 4–6 weeks and underwent canal wall down mastoidectomy. Neurosurgical intervention was considered in the required patients. The case fatality rate in our study was 2.8% (4 patients). Conclusion Otogenic intracranial complications can be fatal if not managed appropriately and timely. Broad spectrum intravenous antibiotics are usually required for 4–6 weeks with or without neurosurgical intervention and mastoid exploration. A high index of suspicion is required in all patients presenting with danger symptoms. [ABSTRACT FROM AUTHOR]

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A nine-year-old male had a cholesteatoma of the mastoid and middle ear found incidentally after myringotomy tube placement. Associated asymptomatic sigmoid plate dehiscence with sinus invasion or thrombosis and ossicular chain destruction complicated his case. He had canal wall down tympanomastoidectomy and was followed for 4.5 years. Disease recurrence necessitated revision. Our case highlights an unusual clinical presentation, possible complications, and the aggressive quality of a benign lesion common in the pediatric population. To our knowledge, this is the first report of an asymptomatic lateral sinus obstruction secondary to an invasive cholesteatoma in this population. [ABSTRACT FROM AUTHOR]

Mastoiditis is a known cause of cerebral venous thrombosis but rarely presents as an isolated laterals sinus thrombosis (LST) and venous infarct. We report an adult female patient who presented with chronic mastoiditis complicated by LST and venous infarct, documented by computerised tomography and magnetic resonance venography. This implicates mastoiditis as a potential and important cause of isolated LST and venous infarcts in brain. [ABSTRACT FROM AUTHOR]

Objectives Otogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations. Methods At a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years. Results All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy ± trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus ( p = 0.029). Conclusion LST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis. [ABSTRACT FROM AUTHOR]

Objective To describe a case of lateral sinus insufficiency, presumably occurring just prior to lateral sinus thrombosis (LST), and to discuss the importance of early surgical intervention and the pathophysiology of full-blown LST. Case report A 4-year-old boy developed headaches and vomiting after exhibiting typical symptoms of acute otitis media. Contrast-enhanced CT revealed narrowing of the sigmoid sinus medially by gas and low-density material. We diagnosed the patient with suspected LST and consequently performed mastoidectomy. A large amount of bloody pus was found in the mastoid cavity and below the bony sinus plate. Sigmoid sinus blood flow was completely restored after drainage of the hemorrhagic and purulent material, and the patient recovered fully. Conclusion Because of the anatomical features of the dural venous sinus, hemorrhage per diapedesis may be strongly associated with the development of LST. In the patient with suspected LST, early diagnosis and surgery prior to the development of intravenous thrombus are key for full recovery from this condition. [ABSTRACT FROM AUTHOR]