Sinus Vein Thrombosis in Pediatric Patients After Acute Mastoiditis

Acute mastoiditis (AM), a complication of acute otitis media, remains a concern despite medical advancements and often leads to severe complications such as cerebral sinus vein thrombosis (CSVT). This study aimed to characterize the clinical, microbiological, and hematological aspects of CSVT secondary to AM in children while assessing the necessity of thrombophilia evaluation in these patients.

A retrospective analysis was conducted on pediatric patients with CSVT secondary to AM between January 2015 and December 2022. This study examined clinical data, laboratory and microbiological results, imaging studies, treatment approaches, and patient outcomes.

Seventeen pediatric patients with a mean age of 3 years were included in this study. Most patients were female (76.5%) and of Jewish ethnicity (82.4%). Group A Streptococcus is the primary pathogen responsible for this condition. The treatment plan involved the administration of intravenous antibiotics and surgical intervention, including cortical mastoidectomy and ventilation tube insertion. Additionally, anticoagulation therapy with Clexane® was initiated and continued for at least 3 months post event. Follow-up imaging revealed recanalization in most cases within an average of 3 months. Hematologic follow-up revealed no recurrent thrombotic events and low thrombophilia incidence.

Cerebral sinus vein thrombosis following AM is a provoked thrombotic event effectively managed with Clexane®. Thrombophilia evaluation may be reserved for patients with a high suspicion of underlying hematological conditions. Follow-up imaging within 3 months post event may be premature.