Visual and neurologic deterioration in otogenic lateral sinus thrombosis: 15 year experience.

Abstract

OBJECTIVES:

Otogenic lateral sinus thrombosis is a rare complication of acute otitis media whose clinical presentation has changed with the early use of antibiotics. The aim of this study was to analyze the changing clinical signs, vaccination status, therapeutic management and outcome of these patients.

METHODS:

Retrospective chart review of 10 children treated with otogenic lateral sinus thrombosis in a tertiary level teaching hospital in Budapest, Hungary, from January 1998 till August 2013.

RESULTS:

Patients were divided into Early and Late presenting groups. In the Early presenting group, sepsis developed within one week after the onset of acute otitis media. At admission otological symptoms were predominant. The Late presenting group experienced acute otitis media several weeks prior to presentation and in this group neurologic symptoms dominated the clinical picture at admission. All patients received antibiotics. Eight of them were also treated with low molecular weight heparin. All children underwent cortical mastoidectomy. After surgery, the clinical signs of elevated intracranial pressure transiently worsened. This manifested as progression of papilledema in seven children, causing severe visual disturbance in two cases. After medical treatment and serial lumbar punctures all patients except one recovered. This child has permanent visual acuity failure of 0.5D unilaterally. At one year follow up complete and partial recanalization were noted in five and two patients, respectively.

CONCLUSIONS:

After mastoidectomy the signs of elevated intracranial pressure can transiently worsen, papilledema can progress. Daily bedside monitoring of visual acuity and regular ophthalmoscopy with neurologic examination is recommended during hospitalization. Close follow up is advised up to one year. When the dominant sinus is occluded, the clinical scenario is more protracted and severe.

• Authors: Beáta Rosdy, Zsuzsanna Csákányi, Katalin Kollár, Judit Móser, Mónika Mellár, Andrea Kulcsár, Éva Kovács, György Várallyay, Gábor Katona
• Journal: International journal of pediatric otorhinolaryngology (Int J Pediatr Otorhinolaryngol) Vol. 78 Issue 8 Pg. 1253-7 (Aug 2014) ISSN: 1872-8464 [Electronic] Ireland
• PMID: 24933360 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Anticoagulants
• Anticonvulsants
• Heparin, Low-Molecular-Weight
• C-Reactive Protein
• Acetazolamide

Topics

• Acetazolamide (therapeutic use)
• Acute Disease
• Anti-Bacterial Agents (therapeutic use)
• Anticoagulants (therapeutic use)
• Anticonvulsants (therapeutic use)
• C-Reactive Protein (analysis)
• Child
• Child, Preschool
• Female
• Heparin, Low-Molecular-Weight (therapeutic use)
• Hospitalization
• Humans
• Intracranial Hypertension (complications, etiology, therapy)
• Lateral Sinus Thrombosis (etiology, therapy)
• Leukocyte Count
• Male
• Mastoid (surgery)
• Neurologic Examination
• Otitis Media (complications)
• Papilledema (etiology, therapy)
• Retinal Hemorrhage (etiology, therapy)
• Retrospective Studies
• Sepsis (drug therapy, etiology)
• Thrombectomy
• Vision Disorders (etiology, therapy)