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Cerebral Venous Sinus Thrombosis Complicating Middle Ear Infections: A Rare Complication in Post-Antibiotic Era

Sarvesh C Mishra1, Isha Tyagi2, Aviral Gupta3

  • 1Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND.

Cureus
|November 23, 2021
PubMed

Insights

Cerebral venous sinus thrombosis (CVST) is a rare complication of middle ear infections. This case highlights a young male with otomastoiditis, CVST, and meningitis, emphasizing the need for advanced imaging despite subtle clinical signs.

Area of Science:

  • Otolaryngology
  • Neurology
  • Infectious Diseases

Background:

  • Intracranial and extracranial complications of middle ear infections are rare in the post-antibiotic era.
  • Cerebral venous sinus thrombosis (CVST), a historically common complication, is now infrequently observed.

Observation:

  • A 27-year-old male presented with severe headache and intractable vomiting.
  • A history of prior right ear discharge was noted, which had resolved with prior medical management.
  • Clinical examination revealed no signs of meningeal irritation or mastoid tenderness.

Findings:

  • Contrast-enhanced magnetic resonance imaging (CEMRI) and venography (CEMRV) revealed right-sided otomastoiditis.
  • The otomastoiditis was complicated by cerebral venous sinus thrombosis (CVST) and meningitis.
  • Diagnosis was confirmed despite the absence of typical clinical signs.

Implications:

  • This case underscores the importance of considering rare complications like CVST and meningitis in patients with otomastoiditis, even with atypical clinical presentations.
  • Prompt diagnosis via advanced neuroimaging is crucial for effective management.
  • Treatment with anticoagulation and antibiotics led to significant clinical improvement, highlighting the efficacy of combined therapeutic strategies.
Keywords:
cerebral venous sinus thrombosis (cvst)contrast enhanced magnetic resonance imaging (cemri)low molecular weight heparin (lmwh)otomastoiditispost-antibiotic era

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