Otogenic Lateral Sinovenous Thrombosis in Children: A Case Series from a Single Centre and Narrative Review

J Stroke Cerebrovasc Dis. 2020 Oct;29(10):105184. doi: 10.1016/j.jstrokecerebrovasdis.2020.105184. Epub 2020 Jul 31.

Abstract

Aim: We aimed to describe otogenic lateral sinovenous thrombosis (OLST), a rare, potentially life-threatening complication of otomastoiditis.

Methods: Children diagnosed with OLST in a tertiary-care Hospital from 2014 to 2019 was retrospectively selected. Clinical and radiological features, timing of diagnosis, treatment and outcome are reported.

Results: Seven children (5 males) were studied. Fever and neurological symptoms (headache, lethargy, diplopia, dizziness and papilledema) were always present. Otalgia and/or otorrhea were found in 6 children; none had signs of mastoiditis. Diagnosis was reached after 7 days (median) from clinical onset. Brain CT-scan was performed in 5 children being diagnostic for 3. Venography-MRI detected OLST and mastoiditis in all cases without parenchymal lesions. Treatment was based on intravenous rehydration, antibiotic and low-molecular weight heparin; acetazolamide was added in 3 children. Mastoidectomy and ventriculoperitoneal-shunting were selectively performed. Patients were discharged after 26 days (median). Follow-up neuroimaging showed sinus recanalization after a median time of 6 months.

Conclusion: A multidisciplinary approach is needed to optimize diagnostic-therapeutic protocols of pediatric OLST.

Keywords: Children; Headache; Otogenic sinovenous thrombosis; Otomastoiditis; Papilledema.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Age Factors
  • Anti-Bacterial Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Carbonic Anhydrase Inhibitors / therapeutic use
  • Cerebrospinal Fluid Otorrhea / complications*
  • Cerebrospinal Fluid Otorrhea / diagnosis
  • Cerebrospinal Fluid Otorrhea / therapy
  • Child
  • Child, Preschool
  • Earache / complications*
  • Earache / diagnosis
  • Earache / therapy
  • Female
  • Fluid Therapy
  • Humans
  • Lateral Sinus Thrombosis / diagnostic imaging
  • Lateral Sinus Thrombosis / etiology*
  • Lateral Sinus Thrombosis / therapy
  • Male
  • Mastoidectomy
  • Mastoiditis / complications*
  • Mastoiditis / diagnosis
  • Mastoiditis / therapy
  • Retrospective Studies
  • Treatment Outcome
  • Ventriculoperitoneal Shunt

Substances

  • Anti-Bacterial Agents
  • Anticoagulants
  • Carbonic Anhydrase Inhibitors