1/45. lemierre syndrome and acute mastoiditis.lemierre syndrome seldom follows an episode of pharyngotonsillitis. Characteristically, it is comprised of septic thrombosis of the internal jugular vein and bacteremia, leading to lung emboli and metastatic abscess formation. We describe lemierre syndrome that complicates an acute mastoiditis, with considerations regarding its pathogenesis and management. Despite its sporadic occurrence, awareness of lemierre syndrome is important, since early recognition reduces both the morbidity and mortality associated with it.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
2/45. Central venous sinus thrombosis following mastoiditis: report of 4 cases and literature review.The frequency of mastoiditis and its complications have declined since the advent of antibiotics. Among all complications, transverse sinus thrombosis is the least frequent, although it may have the highest mortality rate. Before the introduction of surgery and antibiotic treatment, mortality was close to 100%. Previous administration of antibiotics may lead to changes in the clinical presentation of venous sinus thrombosis that make diagnosis more difficult, in spite of greatly improved imaging methods. This article reports 4 confirmed cases of venous sinus thrombosis complicating mastoiditis that were diagnosed and treated at Nossa Senhora das Gracas Hospital, Curitiba--PR from June, 1999, to February, 2000. All 4 cases were documented by magnetic resonance imaging. Each patient recovered after treatment with antibiotics and anticoagulation. No surgical intervention was necessary. Diagnosis of the complication requires a high level of clinical suspicion and then evaluation by mastoid CT and cranial MRI.- - - - - - - - - - ranking = 7keywords = thrombosis (Clic here for more details about this article) |
3/45. Otogenic lateral sinus thrombosis--a case report.INTRODUCTION: We portray and discuss a case of lateral sinus thrombosis following acute otitis media and mastoiditis. CLINICAL PICTURE: The patient presented with otorrhoea, otalgia, neck pain, fever and chills. TREATMENT: Cortical mastoidectomy was performed. Intravenous antibiotics and heparin were administered. OUTCOME: The patient had a complete recovery with no sequelae. CONCLUSIONS: Neurotologic complications of suppurative otitis media like meningitis, cerebral abscess, extradural abscess and dural sinus thrombosis are rare in the antibiotic era. Hence, doctors today have to maintain extra vigilance and a high index of suspicion for such complications.- - - - - - - - - - ranking = 6.0008649746922keywords = thrombosis, cerebral (Clic here for more details about this article) |
4/45. Combined risk factors contributing to cerebral venous thrombosis in a young woman.Cerebral venous thrombosis is a rare condition affecting predominantly adolescents or young adults. The presentation is often non-specific, and delay in diagnosis is common. The otolaryngologist may be consulted about the radiological findings of lateral sinus thrombosis and mastoid changes. The association of congenital thrombophilia with unusual presentations of venous thrombosis, especially in young individuals is now well documented. We present a case of lateral and sagittal sinus thrombosis complicated by cerebral venous infarction in a girl with protein c deficiency and masked mastoiditis. Unusual forms of venous thrombosis, including cerebral venous thrombosis may develop in association with a single risk factor for thrombosis, but additional risk factors should be sought especially when thrombosis presents in very young individuals. This case draws attention to the multi-causal nature of cerebral venous thrombosis in young adults, and highlights the issue of masked mastoiditis. A coordinated approach by otolaryngological and haematological teams is recommended in such cases.- - - - - - - - - - ranking = 13.006054822845keywords = thrombosis, cerebral (Clic here for more details about this article) |
5/45. Sigmoid sinus thrombosis: an old foe revisited.Sigmoid sinus thrombosis (SST) has become increasingly uncommon. In the pre-antibiotic era this condition had a mortality rate of over 90%.1 A high index of suspicion is required to make the diagnosis. We present a rare case of sigmoid sinus thrombosis secondary to mastoiditis, which illustrates the problems of delayed diagnosis. This report highlights the importance of rapid diagnosis and early surgical intervention. We emphasis the need for scanning and otolaryngology referral in all cases of middle ear disease associated with pain or vertigo which does not resolve rapidly on appropriate antibiotic therapy.- - - - - - - - - - ranking = 6keywords = thrombosis (Clic here for more details about this article) |
6/45. Intracranial complications of acute and chronic mastoiditis: report of two cases in children.OBJECTIVE: The clinical picture of mastoiditis, sigmoid sinus thrombosis and brain abscess has changed with the advent of antibiotics. A delay in the recognition of intracranial complications in children and in the institution of appropriate therapy may result in morbidity and mortality. Increased mortality of the children has been correlated with the neurological status of the patient on admission to hospital. METHOD: A retrospective study was made of two children with acute mastoiditis and sigmoid sinus thrombosis and chronic mastoiditis with cerebellar abscess treated in 1997 in the ENT Department of the Medical University of Gdansk. RESULTS: We present two cases of intracranial complications in children (13 and 11 years old) originating from acute and chronic otitis media. The first case, of a 13-year-old boy with sigmoid sinus thrombosis as a complication of acute otitis media took its course as a typical Symonds Syndrome. Mastoidectomy, thrombectomy and jugular vein ligation associated with antibiotics and edema-reducing drugs and anticoagulants proved to be successful. The second case of an 11-year-old boy with exacerbated chronic otitis media with cholesteatoma and mastoiditis, was complicated by suppurative meningitis, cerebellar abscess, perisinual abscess and sigmoid sinus thrombophlebitis. Neurosurgical approach by suboccipital craniotomy and abscess drainage was ineffective. Otological treatments of modified radical mastoidectomy, thrombectomy, jugular vein ligation, perisinual and cerebellar abscess drainage associated with wide-spectrum antibiotics and edema-reducing drugs were performed with a very good outcome. After 3 years of follow-up the patients remain without any neurological and psychiatric consequences. CONCLUSION: The authors show different courses of both presented complications and imaging techniques and surgical procedures performed in these children. The sigmoid sinus trombosis with Symonds Syndrome may be difficult to diagnose due to previous antibiotics valuable in establishing the diagnosis and the extent of disease. The successful therapy is based on understanding of pathogenesis of the intracranial complication and the cooperation of an otolaryngologist, a neurologist, a neurosurgeon and an ophthalmologist.- - - - - - - - - - ranking = 3.0003186783459keywords = thrombosis, brain (Clic here for more details about this article) |
7/45. natural history of sigmoid sinus thrombosis.To demonstrate the evolution of sigmoid sinus thrombosis, we performed a prospective observational study on a 6-year-old girl who presented with mastoiditis, epidural abscess, and occipital osteomyelitis from multiple drug-resistant streptococcus pneumoniae. She underwent mastoidectomy and partial occipital craniectomy. This procedure produced a window in the occipital bone that allowed serial ultrasonography of the sigmoid sinus during medical treatment. Computed tomography was performed, followed by weekly Doppler ultrasonography used to monitor resolution of sigmoid sinus thrombosis. The natural history of a treated episode of sigmoid sinus thrombosis was illustrated. Venous occlusion resolved over a 4- to 6-week period without surgical drainage or venous anticoagulants. Collateral flow, reversal of normal venous flow, and ultimate return to normal venous transport characterized the period of resolution. We conclude that an occluded sigmoid sinus from mastoiditis can naturally recanalize. Aberrant venous flow can be demonstrated during the period of resolution. This case supports a conservative approach to management of the occluded sinus and suggests that 4 to 6 weeks of antibiotic therapy after removal of perisinus infection is sufficient for cure.- - - - - - - - - - ranking = 7keywords = thrombosis (Clic here for more details about this article) |
8/45. Otomastoiditis-related facial nerve palsy.A 9-year-old girl with persistent otitis media, despite antibiotic therapy developed a facial nerve palsy. Computed tomography (CT) scan revealed ipsilateral mastoiditis, prompting admission for intravenous antibiotic and steroid therapies. Acute mastoiditis, uncommon in the post-antibiotic era, is usually diagnosed on physical examination findings, but two variants, masked mastoiditis or silent mastoiditis, may be difficult to appreciate clinically. patients who present with facial nerve palsy in the setting of persistent otitis media should undergo CT scan for evaluation of intracerebral or extracerebral pathology, including mastoiditis. Failure to identify associated concomitant pathology may result in treatment failure or persistent neurological deficit.- - - - - - - - - - ranking = 0.0017299493843781keywords = cerebral (Clic here for more details about this article) |
9/45. MRI findings in a child with sigmoid sinus thrombosis following mastoiditis.We describe the MRI features of sigmoid sinus thrombosis following mastoiditis in a 3-year-old girl. The features consisted of increased signal from the sinus on T2-weighted images and absence of flow on MR venography. It is concluded that MRI enabled a timely diagnosis of this life-threatening disease. MRI, as a non-invasive technique that does not use ionizing radiation, should be considered the investigation of first choice, especially in young patients.- - - - - - - - - - ranking = 5keywords = thrombosis (Clic here for more details about this article) |
10/45. otitis media and CNS complications.Intracranial complications from otitis media can be quite devastating to the patient if an early diagnosis is not made. patients may develop meningitis, venous sinus thrombosis or cranial nerve palsies, as well as intracranial abscess. The presenting features in such cases may be subtle and include headache, nausea, vomiting, personality changes and signs of increased intracranial pressure as well as focal neurological deficits. A case of intracranial brain abscess is presented in a patient with a history of chronic otitis media with cholesteatoma. Delay in the diagnosis of intracranial complications of otitis media can lead to improper treatment with increased morbidity and mortality. The etiology and treatment of complications affecting the CNS is discussed.- - - - - - - - - - ranking = 1.0003186783459keywords = thrombosis, brain (Clic here for more details about this article) |
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