title: Acute mastoiditis: the role of imaging for identifying intracranial complications.
abstract: OBJECTIVE
  Brain CT is performed in patients presenting with acute mastoiditis (AM) to identify intracranial complications (ICC). Recently, however, the need for CT scans in such patients has been questioned owing to concerns regarding long-term effects of brain irradiation, with some clinicians claiming that the decision to scan should be based on a patient's clinical presentation. This study was aimed at characterizing the typical clinical presentation of patients who already have ICCs when diagnosed with AM, and to compare it to that of AM patients presenting without ICCs.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  All patients hospitalized with AM between July 1997 and December 2009 in an otologic tertiary referral center were divided into those with and those without ICCs on presentation. Prereferral clinical characteristics and the signs, symptoms, and inflammatory indexes at presentation were compared between the two groups.
  
  
  RESULTS
  Of 71 patients presenting with AM, 10 had at least one ICC (sigmoid sinus thrombosis [nine patients], perisinus empyema [five patients], subdural abscess [one patient], and epidural abscess [one patient]). Patients with and without ICCs did not differ regarding most clinical characteristics or presenting signs and symptoms. None presented with neurological signs or cranial nerve deficits.
  
  
  CONCLUSIONS
  It is not possible to define an evidence-based index of suspicion for ICCs in patients with AM. Diagnostic imaging at presentation accordingly remains mandatory.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel. michal.luntz@b-zion.org.il
authors.forename: Michal
authors.initials: M
authors.lastname: Luntz
authors.forename: Keren
authors.initials: K
authors.lastname: Bartal
authors.forename: Alexander
authors.initials: A
authors.lastname: Brodsky
authors.forename: Rabia
authors.initials: R
authors.lastname: Shihada
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001922:Brain Abscess / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D013354:Empyema, Subdural / Q000000981:diagnostic imaging* / Q000209:etiology; D020802:Epidural Abscess / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008417:Mastoiditis / Q000150:complications* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D015203:Reproducibility of Results; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*