title: Visual and neurologic deterioration in otogenic lateral sinus thrombosis: 15 year experience.
abstract: OBJECTIVE
  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.affiliation: Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary. Electronic address: rosdybea@gmail.com.
authors.forename: Beáta
authors.initials: B
authors.lastname: Rosdy
authors.affiliation: Department of ENT & Bronchology, Heim Pál Children's Hospital, Budapest, Hungary. Electronic address: csakanyi.zsuzsanna@gmail.com.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Csákányi
authors.affiliation: Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary. Electronic address: kollark@gmail.com.
authors.forename: Katalin
authors.initials: K
authors.lastname: Kollár
authors.affiliation: Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary. Electronic address: jmoser5@gmail.com.
authors.forename: Judit
authors.initials: J
authors.lastname: Móser
authors.affiliation: Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary.
authors.forename: Mónika
authors.initials: M
authors.lastname: Mellár
authors.affiliation: Department of Paediatric Infectology, United St István and St László Hospital, Budapest, Hungary. Electronic address: andrea.kulcsar@laszlokorhaz.hu.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kulcsár
authors.affiliation: Department of Radiology, Heim Pál Children's Hospital, Budapest, Hungary. Electronic address: ekovacsuab@hotmail.com.
authors.forename: Éva
authors.initials: É
authors.lastname: Kovács
authors.affiliation: Semmelweis Medical School MR Research Center, Budapest, Hungary. Electronic address: varally@gmail.com.
authors.forename: György
authors.initials: G
authors.lastname: Várallyay
authors.affiliation: Department of ENT & Bronchology, Heim Pál Children's Hospital, Budapest, Hungary. Electronic address: g.katona@t-online.hu.
authors.forename: Gábor
authors.initials: G
authors.lastname: Katona
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications* / Q000209:etiology* / Q000628:therapy; D020227:Lateral Sinus Thrombosis / Q000209:etiology* / Q000628:therapy; D007958:Leukocyte Count; D008297:Male; D008416:Mastoid / Q000601:surgery; D009460:Neurologic Examination; D010033:Otitis Media / Q000150:complications; D010211:Papilledema / Q000209:etiology* / Q000628:therapy; D012166:Retinal Hemorrhage / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology; D017131:Thrombectomy; D014786:Vision Disorders / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D000927:Anticonvulsants; D006495:Heparin, Low-Molecular-Weight; D002097:C-Reactive Protein; D000086:Acetazolamide
keywords: Acute otitis media; Anticoagulation; Intracranial pressure; Lateral sinus thrombosis; Mastoidectomy; Papilledema; Sigmoid sinus thrombosis