Cerebral Sinus Venous Thrombosis in the Setting of Acute Mastoiditis

Cerebral sinus venous thrombosis (CSVT) is a rare complication of acute mastoiditis with a declining incidence in the post-antibiotic era. In the adult population its incidence ranges from three to four cases per million. Here we present a case of a 47-year-old female with triple negative breast cancer on chemotherapy who underwent a molar tooth extraction, which was followed two weeks later by the sudden onset of left-sided frontotemporal headache radiating down the face, left ear fullness with associated hearing loss, toothache, and left orbital pain. Imaging studies performed included magnetic resonance imaging (MRI) as well as magnetic resonance venography (MRV), both of which showed thrombosis of the left transverse sinus, sigmoid sinus as well as the internal jugular vein, which was consistent with a diagnosis of cerebral sinus venous thrombosis. Following the diagnosis, the patient was managed with anti-coagulation and antibiotics, which resulted in improvement of her symptoms. This case highlights the need to be vigilant in patients with acute mastoiditis for the above clinical syndrome in order to promptly diagnose this rare complication and avoid life-threatening consequences.