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PubMed2000

Lateral sinus thrombosis after untreated otitis media. A clinical problem--again?

Antimicrobial agents have greatly reduced the incidence of intracranial complications of infections of the middle ear and mastoid. Too many prescriptions and overconsumption of antibiotics when otitis media is suspected has caused resistance to many antibiotics, leading to a pronounced and justifiable desire to reduce the widespread excessive use of antibiotics. The possible untoward consequences of a too restricted antibiotic policy, however, is illustrated by the following case of a 14-year-old boy who, after non-treatment of an ear infection, fell ill with one-sided headache and vomiting caused by a lateral sinus thrombosis. After intravenous treatment with antibiotics, anticoagulants and ventilation of the middle ear, the infection was cured without complications. This case calls attention to the symptoms of otitic complications arising outside the temporal bone. The physician must always bear in mind the possibility of an unusual event. The general treatment of endocranial complications is outlined, giving details of the treatment given in this special case. We stress that one should not be too cautious in prescribing antibiotics in otitis media.

Adolescent↗
PubMed2001

Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998.

There is insufficient information on the prognosis and safety of anticoagulation in acute cerebral vein and dural sinus thrombosis (CVDST). To describe the clinical aspects and medical management of CVDST in Portuguese hospitals, to evaluate the safety of anticoagulation in this setting, and to identify subgroups of CVDST patients with different prognoses, we registered symptomatic CVDST patients admitted to Portuguese hospitals since 1980. Cases were collected from file review up to 6/95 and from consecutively admitted patients from 6/95 to 6/98. One hundred and forty-two patients were included from 20 centers (51 retrospectively and 91 prospectively). One hundred and twelve patients (79%) were anticoagulated. There were only 6 new intracranial hemorrhages (4 in anticoagulated patients) and 2 systemic hemorrhages. Nine (6%) patients died. At discharge, 96 (68%), had recovered completely and only 6 (4%) were dependent (Rankin > or = 3). Significant multivariate predictors of death/dependency were central nervous system infection as a predisposing cause (odds ratio, OR = 15.4; 95% confidence interval CI = 111-1.1), encephalopathy on admission (OR = 5.2; 95% CI = 18.7-1.5) and hemorrhage on admission CT/MR (OR = 3.6; 95% CI = 12.9-1). Significant predictors of complete recovery were no encephalopathy on admission (OR = 5; 95% CI = 12.5-2.1), age < 45 years (OR = 3.8; 95% CI = 9.2-1.6) and anticoagulation (OR = 3.8; 95% CI = 9.6-1.5). It is possible to identify CVDST patients with potential bad or good prognosis in the acute phase. Anticoagulation was safe and a predictor of complete recovery in acute CVDST.

Adult↗
PubMedDate not supplied

[Cerebral vein and sinus thrombosis--an important cause of benign intracranial pressure increase in childhood].

The syndrome of raised intracranial pressure without any space-occupying lesion (pseudotumor cerebri) is still of unknown etiology. To some degree, secondary causes can be found. With respect to the therapeutical possibilities, a clinically important cause is the thrombosis of a major cerebral sinus. In children it is sometimes associated with otitis media. However, clinical signs of mastoiditis can be missed because of previous antibiotic treatment. We observed 11 children with pseudotumor cerebri. Four children suffered from an occlusion of a lateral major sinus after otitis media. The treatment with heparin in the acute stage and later on with acetylsalicylic-acid led to complete recovery. Our results suggest that the thrombosis of a major cerebral sinus induced by an otitis media is a frequent cause of pseudotumor cerebri in children and should be excluded by MRI or angiography in any doubtful case. In contrast to the treatment of adults, long term anticoagulation is not necessary.

Adolescent↗
PubMed1978

Superior sagittal sinus thrombosis: an evaluation of the changes demonstrated on computed tomography.

Five female patients, all either on contraceptive medication or in the postpartum period, with angiographically confirmed superior sagittal sinus thrombosis have been scanned. CAT appearances are nonspecific, but when taken in conjuction with the symptoms should suggest the possible diagnosis. The most consistent appearance was of diffuse cerebral swelling with subsequent return to normal. Bilateral low attenuation lesions with haemorrhagic areas were noted in one patient.

Adult↗
PubMed1995

Lateral sinus thrombosis complicating mastoiditis.

Although otitis media is easily recognized in the emergency department, its complications can often be missed. We present the case of a patient with mastoiditis with lateral sinus thrombosis that was not diagnosed until a digital subtraction angiogram revealed the occlusion.

Adult↗
PubMedDate not supplied

[Venous sinus thrombosis in puerperium].

UNLABELLED: BACKGROUND, PATIENT RESPECTIVELY AND METHODS: Based on a case-report we demonstrate which symptoms are indicative of a cerebral sinus-venous thrombosis, how it can develop, and which diagnostic and therapeutic methods are available. RESULTS: Cerebral sinus-venous thrombosis in puerperium can be hidden behind unspecific symptoms like strong headache, nausea, vomiting. Literature reorts varying mortality between 5 and 30%. CONCLUSIONS: The obstetrician has to be attentive whenever these symptoms appear for the course and prognosis decisively depend on a quick diagnosis by means of computertomography and angiography. DISCUSSION: Blood coagulation disorders such as lack of Antithrombin III, protein C, or protein S, have been identified as a particularly important origin of the cerebral sinus-venous thrombosis. It is subject to discussion whether the patient should be advised against any further pregnancy. From a medical point of view, a subsequent pregnancy seems acceptable because the risk of another thrombosis, which is a rare event anyway, can be significantly reduced by providing anticoagulation substances.

Adult↗
PubMedDate not supplied

Experimental production of superior sagittal sinus thrombosis in the dog.

Prior efforts at experimental production of superior sagittal sinus (SSS) thrombosis generally have been unsuccessful. An experimental method was devised of inducing SSS thrombosis in the dog by use of double-lumen balloon catheters. Two balloon catheters, introduced into each internal jugular vein, are finally positioned at the torcular Herophili. The resulting stasis in the SSS, initiated by the inflated balloons, is augmented by injecting thrombin into the SSS. The stasis and the intraluminal thrombin cause thrombosis, which can be visualized on computed tomography (CT). This method may be used to study the natural history of SSS thrombosis as well as establish its CT and magnetic resonance imaging characteristics.

Animals↗
PubMed1982

Superior sagittal sinus thrombosis associated with androgen therapy for hypoplastic anemia.

Of 27 patients with hypoplastic anemia treated between 1971 and 1974 with male hormone and protein-assimilating hormone, 3 developed superior sagittal sinus thrombosis (SSST). The clinical symptoms and signs and angiographic findings of SST were characteristic enough to allow an early diagnosis. Signs related to SST were seizures, hemiplegia, facial palsy, stupor, and coma, with the most important prodrome and consistent subjective complaint being headache. Following discontinuation of the hormone therapy, neurological signs and symptoms related to SSST gradually subsided. In all cases, the hematological picture improved with discontinuation of the hormone therapies. It appears that administration of male hormone can be associated with the development of SSST. If neurological symptoms and signs of SSST appear, administration of the hormones should be discontinued.

Adult↗
PubMed2001

Dural arteriovenous fistula associated with neoplastic dural sinus thrombosis: two cases.

Intracranial dural arteriovenous fistulae are direct arteriovenous shunts within the dura matter. We report two cases of arteriovenous fistulae upstream to a neoplastic dural sinus thrombosis. These cases add further support to the acquired etiology of dural arteriovenous fistulae and to the fact that venous hypertension is one of the most important precipitating factors.

Arteriovenous Fistula↗
PubMed2002

Venous sinus thrombosis after Proteus vulgaris meningitis and concomitant Clostridium abscess formation.

A 19-y-old woman presented with Proteus vulgaris meningitis as a complication of chronic otitis media. Despite treatment with ceftazidime and amikacin no clinical improvement was observed. Cranial MRI revealed right-sided mastoiditis/otitis media and venous sinus thrombosis. After mastoidectomy, repeat cranial MRI demonstrated abscess formation in the venous sinuses. The abscess was drained. Clostridium spp. was isolated from the abscess culture.

Adult↗