Catastrophic cerebral venous sinus thrombosis secondary to fulminant invasive otomastoiditis

A previously healthy, middle-aged immunocompetent man presented to a regional hospital with a 12-h history of right ear pain and discharge following a mild flu-like illness. He rapidly deteriorated neurologically, developing dilated pupils and seizures requiring intubation. Following urgent transfer to a quaternary ICU, multidisciplinary assessment (ENT and Neurosurgery), neuroimaging, and right ear myringotomy confirmed Otomastoiditis with catastrophic cerebral venous sinus thrombosis. CT venography demonstrated extensive thrombosis involving the right sigmoid, transverse, and superior sagittal sinuses. Myringotomy revealed culture-negative blood-stained pus. Pulmonary microbiology results were positive for Influenzae B and the Aspergillus fumigatus complex. Despite maximal medical management, the patient developed bilateral venous infarctions, cerebral edema, and cerebellar tonsillar herniation, progressing to brain death within 48 h. Organ donation proceeded in accordance with his prior wishes. Otomastoiditis can cause rapid, fatal intracranial complications even in healthy individuals, highlighting the need for early imaging, specialist input, and vigilance for neurological decline.