title: Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management.
abstract: OBJECTIVE
  Otogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations.
  
  
  METHODS
  At a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years.
  
  
  RESULTS
  All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029).
  
  
  CONCLUSIONS
  LST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis.
authors.affiliation: Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy. Electronic address: elisabetta.zanoletti@tiscali.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Zanoletti
authors.affiliation: Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cazzador
authors.affiliation: Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Faccioli
authors.affiliation: Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Sari
authors.affiliation: Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bovo
authors.affiliation: Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Martini
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D020227:Lateral Sinus Thrombosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008416:Mastoid / Q000601:surgery; D008417:Mastoiditis / Q000175:diagnosis / Q000209:etiology; D008876:Middle Ear Ventilation / Q000009:adverse effects; D010033:Otitis Media / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D010690:Phlebography; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants
keywords: Acute mastoiditis; Children; Lateral sinus thrombosis; Otitis media; Venous sinus thrombosis