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Intracranial hypertension secondary to sigmoid sinus compression by group A streptococcal epidural abscess

J P Ludemann1, K Poskitt, A Singhal

  • 1Division of Otolaryngology, British Columbia Children's Hospital and University of British Columbia, British Columbia, Canada. jludemann@cw.bc.ca

The Journal of Laryngology and Otology
|August 4, 2009
PubMed

Insights

A rare case of severe intracranial hypertension in a child was caused by a Group A Streptococcus epidural abscess compressing the sigmoid sinus. Prompt surgical intervention led to complete symptom resolution without sequelae.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Otolaryngology

Background:

  • Intracranial hypertension can arise from various causes, including venous sinus compression.
  • Group A Streptococcus (GAS) is a common pathogen, but epidural abscesses are rare complications.

Observation:

  • A five-year-old boy presented with severe intracranial hypertension following treatment for acute otitis media and GAS bacteremia.
  • Imaging revealed significant compression of the dominant right sigmoid sinus by a small epidural abscess, without evidence of thrombosis.

Findings:

  • Surgical decompression of the epidural abscess and debridement of the sigmoid sinus wall resulted in immediate and complete resolution of intracranial hypertension.
  • The patient experienced no neurological sequelae during a six-month follow-up period.

Implications:

  • This case highlights a novel mechanism of intracranial hypertension: sigmoid sinus compression by an epidural abscess without thrombosis.
  • It underscores the critical need for urgent surgical management of such abscesses, even when small and lacking venous thrombosis.
Abstract

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