Presentation, treatment, and clinical course of otogenic lateral sinus thrombosis

Abstract

In all eight patients, the lateral sinus thrombosis was detected by imaging studies performed to evaluate complications and symptoms related to COM. Fever, headache, and cranial nerve paralysis were the main clinical manifestations associated with coexisting mastoiditis, meningitis, and cerebellar and epidural abscess. We could not identify features specific to lateral sinus thrombosis in any case. All patients underwent mastoidectomy and were given broad-spectrum antibiotics for 2 months. Four cases were anticoagulated and all eight cases experienced complete clinical recovery without sequelae.

Pediatric otogenic lateral sinus thrombosis recanalization

“…The lack of effect seen with anticoagulation on sinus recanalization may be related to the small sample size despite combining data from the present study with seven prior reports [4,8,10,11,15,16,19,20]. These previous reports demonstrate recanalization rates of 0-72% of patients who were anticoagulated and 0-100% of those in whom no anticoagulation was administered [4,8,11,15,16,19,20]. In the present study 79% of patients were anticoagulated resulting in 73% partial or complete recanalization.…”

“…One patient in this series had a presumed anticoagulation related post surgical hematoma which resolved with incision and drainage. Forty-seven patients from eight studies in addition to the present study had follow up imaging data to determine the rate of recanalization with respect to the use of anticoagulation [4,8,10,11,14,15,18,19]. Twenty of 30 (66.7%) patients who were administered anticoagulation showed evidence of recanalization.…”

“…Despite these advances, complications of otitis media still occur, and if not recognized and treated in a timely fashion, may result in significant morbidity and mortality [9]. Otogenic lateral sinus thrombosis is an infrequent complication that is now rarely associated with mortality or permanent morbidity in areas with access to care [10,11]. Goldenberg found that 66% of the otolaryngology departments they surveyed had no episodes of sigmoid sinus thrombosis in the 5 years preceding the survey.…”

“…45 out of 52 (90.4%) patients had a follow up MRI or ultrasound imaging to assess the patency of the affected sinuses [4,8,10,11,14,15,18,19]. Thirty six of fifty two (69.2%) patients were anticoagulated with either low molecular weight heparin, or a combination of heparin and coumadin.…”

Acute mastoiditis in children: A retrospective study of 188 patients

“…There is a lack of comparative trials studying the effectiveness and toxicity of heparin in patients with septic thrombosis [40][41][42]. In our study, none of the sinus thrombosis was cured with heparin treatment.…”