Spontaneous Epidural Haematoma and Sigmoid Sinus Thrombosis due to Pyogenic Mastoiditis in Children: A Case Report

Mastoiditis represents the most common complication of acute otitis media, particularly during the first years of life. Epidural haematomas refer to a life-threatening condition due to the extra-axial collection of blood between the dura matter and the inner table of the skull, more frequently caused by head trauma. In the absence of head trauma, the epidural haematoma is called spontaneous. Sigmoid sinus thrombosis is a rare complication of mastoiditis. A case of a child with an atypical presentation of acute otitis media and mastoiditis and a rare combination of complications, such as spontaneous epidural haematoma secondary to sigmoid sinus thrombosis, is presented.

We present a 4-year-old boy with high fever, vomiting, temporal headache and altered mental status. On repeat efforts to evaluate the tympanic membranes due to poor cooperation, a bulging, inflamed and opacified tympanic membrane alongside an attenuated light reflex were identified in the left ear, confirming the diagnosis of acute otitis media. No redness or swelling of the mastoid process was observed. Due to the worsening mental status, a CT head scan was performed, which revealed left sigmoid sinus thrombosis, an epidural collection and hydrocephalus. The patient underwent urgent extraventricular drain insertion, a left lateral suboccipital craniotomy and evacuation of the epidural collection, which was proven to be a haematoma. After 1 month of intravenous antibiotics and hospitalization, he was discharged home asymptomatic and with no neurological deficits.

We present a case of atypically presenting mastoiditis secondary to otitis media, further complicated by the development of sigmoid sinus thrombosis and epidural haematoma. We highlight the importance of regular physical evaluations in young patients with poor cooperation. Also, in the presence of mastoiditis and neurological symptoms, a brain image scan is crucial for the diagnosis of potentially fatal complications.