Otitic hydrocephalus: an uncommon complication of a common condition

A 14-year-old girl presented with bilateral sixth nerve palsies and papilledema after a two-week history of ear drainage and progressive right-sided temporal headache. A computed tomography scan of the head was normal, as were plain films of the mastoids. Lumbar puncture revealed a markedly elevated opening pressure with an otherwise normal cerebrospinal fluid examination, and she was given the diagnosis of pseudotumor cerebri. Despite treatment with acetazolamide, prednisone, and repeated lumbar punctures, her symptoms worsened. A magnetic resonance imaging study revealed thrombosis of the right sigmoid sinus, and repeat computed tomography showed evidence of mastoiditis. Definitive therapy consisted of a right mastoidectomy and antimicrobial therapy, to which the patient responded promptly. This case illustrates an unusual sequela of otitis media--termed otitic hydrocephalus--that resulted from obstruction of the sigmoid sinus. Although otitis media is generally a benign illness, clinicians must be alert to suppurative complications, which may evolve insidiously.