title: Lateral sinus thrombosis associated with mastoiditis and otitis media in children: a retrospective chart review and review of the literature.
abstract: The authors describe the clinical features and management of lateral sinus thrombosis associated with mastoiditis and otitis media in children. Of 475 patients with mastoiditis and otitis media, 13 (2.7%) had lateral sinus thrombosis identified by magnetic resonance imaging/magnetic resonance venography (n = 11) and angiography (n = 2). Clinical features included headache, vomiting, fever, diplopia, papilledema, sixth nerve palsy, seventh nerve palsy, and unilateral cerebellar ataxia. All patients received antibiotics for 1 to 8 weeks. Four patients underwent mastoidectomy alone, 5 mastoidectomy with concurrent myringotomy and ventilation tube, and 1 myringotomy with tube without mastoidectomy. Three underwent anticoagulation for 6 months (1 had heterozygous factor V Leiden mutation). All survived; deafness occurred in 5 patients (4 transient, 1 persistent). Magnetic resonance imaging/magnetic resonance venography should be obtained in any child with otitis media having features of raised intracranial pressure and/or focal neurodeficits to rule out lateral sinus thrombosis. Antibiotics and mastoidectomy are essential in management. A hypercoagulable state may predispose to lateral sinus thrombosis.
authors.affiliation: Pediatric Neurology Center, Children's Hospital, Cleveland Clinic, Cleveland, Ohio 44195, USA. ghoshd2@ccf.org
authors.forename: Partha S
authors.initials: PS
authors.lastname: Ghosh
authors.forename: Debabrata
authors.initials: D
authors.lastname: Ghosh
authors.forename: Johanna
authors.initials: J
authors.lastname: Goldfarb
authors.forename: Camille
authors.initials: C
authors.lastname: Sabella
mesh_terms: D002648:Child; D003638:Deafness / Q000209:etiology; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008417:Mastoiditis / Q000150:complications*; D010033:Otitis Media / Q000150:complications*; D010690:Phlebography; D011379:Prognosis; D012189:Retrospective Studies