Mastoid Signal Change and Acute Cerebral Venous Sinus Thrombosis: Unlocking the Puzzle

Mastoid signal changes on magnetic resonance imaging in cerebral venous sinus thrombosis (CVT) patients are often misinterpreted as septic CVT. Studies have revealed mastoid signal changes in CVT patients. We conducted this study to investigate this relationship. Single-center, retrospective, observational study. Patients aged ≥18 years with venography-proven CVT were enrolled, excluding those with sepsis-induced CVT. Mastoid changes and clot burden score (CBS) were calculated. We screened and enrolled 128 and 124 CVT patients, respectively. Seventy per cent of patients had mastoid signal changes. The median mastoid score and CBS were 1 and 3, respectively. CBS was higher in CVT patients with mastoid changes. A higher CBS was associated with a higher mastoid score ( P = 0.003). Logistic regression analysis revealed an odds ratio of 0.67 (95% confidence interval: 0.52-0.87) for this association. The presence of radiological mastoid involvement is not sine qua non of associated middle ear infections and should raise the possibility of CVT.