Intracranial hypertension secondary to sigmoid sinus compression by group A streptococcal epidural abscess.
OBJECTIVE
We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess.


METHODS
Case report and review of the world literature.


RESULTS
A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up.


CONCLUSIONS
This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.
Ludemann
J P
JP
Division of Otolaryngology, British Columbia Children's Hospital and University of British Columbia, British Columbia, Canada. jludemann@cw.bc.ca
Poskitt
K
K
Singhal
A
A
D000208:Acute Disease; D002675:Child, Preschool; D019299:Decompression, Surgical; D004388:Dura Mater; D020802:Epidural Abscess / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000628:therapy; D008297:Male; D008416:Mastoid / Q000601:surgery; D010033:Otitis Media / Q000209:etiology; D013290:Streptococcal Infections / Q000150:complications*; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D016896:Treatment Outcome