Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review

Abstract

Background: Cerebral venous sinus thrombosis in children is a rare but potentially fatal complication of acute mastoiditis, one of the most common pediatric infectious diseases. Due to its subtle clinical presentation, suspicion is essential for a prompt diagnosis and appropriate management. Unfortunately, no standard treatment options are available. To discuss the possible clinical presentation, microbiology, and management, we here report the case of a child with otogenic cerebral venous sinus thrombosis and perform a literature review starting from 2011. Case presentation: The child, a 10-months-old male, presented clinical signs of right acute otitis media and mastoiditis. Brain computed tomography scan detected right sigmoid and transverse sinus thrombosis, as well as a subperiosteal abscess. Fusobacterium necrophorum and Haemophilus Influentiae were detected on cultural sampling. A multidisciplinary approach along with a combination of medical and surgical therapy allowed the patient's full recovery. Conclusion: Cerebral venous sinus thrombosis is a rare but severe complication of acute otitis media and mastoiditis. The management of this pathological condition is always challenging and an interdisciplinary approach is frequently required. Current therapeutic options include a combination of medical and surgical therapy. A patient-centered approach should guide timing and treatment management.

Actinomyces and Shewanella algae complicated paediatric mastoiditis: a case report of a multidisciplinary approach

“…A 2020 literature review showed that most cases of paediatric otogenic cerebral venous sinus thrombosis have negative bacterial culture tests of the ear exsudate [9]. Although there are some cases of ear infections caused by S.…”

The Anticoagulant Therapy for Otogenic Sigmoid Sinus Thrombophlebitis: A Case Report and Literature Review

“…Some authors recommended anticoagulant therapy for its potential benefits, such as limiting the spread of thrombus, improving sinus recanalization, and reducing sequelae of the nervous system. 4,7,16,17 Ropposch et al 2 treated patients with ordinary heparin for 3 days after surgery, followed by low molecular weight heparin for 3 months, and reported that no complications occurred. 2,3 Coutinho et al 18 treated 16 children with anticoagulation therapy combined with antibiotics and radical mastoidectomy.…”

“…Due to the extensive use of antibiotics, the incidence of sigmoid sinus thrombophlebitis has been on the rise in recent years, and symptoms which were considered typical of the disease, such as ''picket fence'' fever, headache, dizziness, nausea, vomiting, neck stiffness, erythema, and altered mental status, with otorrhea, retroauricular edema, and pressing pain (Griesinger sign), [4][5][6][7][8] are no longer typical. The patient did not have typical symptoms of ''picket fence'' fever after admission, owing to his treatment with antibiotics before admission.…”

“…The risks of anticoagulant therapy include embolism, drug interactions, induced thrombocytopenia, bleeding, as well as hemorrhagic skin necrosis. [2][3][4][5] Nevertheless, the incidence of complications caused by anticoagulants is low and usually nonfatal, therefore some authors have suggested that it is reasonable to consider anticoagulation treatment before obtaining more evidence. 14 According to the guidelines and recommendations of the British Society of Haematology on the treatment of cerebral venous thrombosis in children, the anticoagulation group achieved better survival and cognitive outcomes, even if there was no evidence that anticoagulation increased the recanalization rate.…”

Acute otitis media-related facial nerve palsy in a child: a case report and a literary review

“…Acute mastoiditis is the most frequent AOM complication. More severe complications such as meningitis, subperiosteal, epidural, or intracerebral abscesses may occur albeit uncommon [ 2 ]. Facial nerve paralysis secondary to concurrent AOM is also possible, even if it is rarely reported in children due to the use of broad-spectrum antibiotics, with only 0.005% of patients developing this condition [ 3 ].…”