Asunto(s)
Vacunas contra la COVID-19/efectos adversos , COVID-19/prevención & control , Trombosis de los Senos Intracraneales/inducido químicamente , Anticoagulantes/uso terapéutico , Autoanticuerpos/inmunología , Angiografía Cerebral , ChAdOx1 nCoV-19 , Heparina/uso terapéutico , Humanos , India , Trombosis del Seno Lateral/inducido químicamente , Trombosis del Seno Lateral/diagnóstico por imagen , Trombosis del Seno Lateral/tratamiento farmacológico , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Flebografía , Factor Plaquetario 4/inmunología , SARS-CoV-2 , Trombosis del Seno Sagital/inducido químicamente , Trombosis del Seno Sagital/diagnóstico por imagen , Trombosis del Seno Sagital/tratamiento farmacológico , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Trombocitopenia , Warfarina/uso terapéuticoRESUMEN
INTRODUCTION: Craniotomy and cranial reconstruction is the most common procedure for children older than 6 months with craniosynostosis. Dural sinus thrombosis after this surgery has not been well reported in the literature. CASE PRESENTATION: This 2-year-old child underwent a bilateral craniotomy and cranial reconstruction for sagittal craniosynostosis. He had a partial thickness tear of the wall of the right transverse sinus which was uneventfully managed. Postoperative imaging showed evidence of bilateral thrombosis of the transverse sinus with a small occipital hemorrhage. He was started on low-molecular-weight heparin. Follow-up imaging showed nonprogression of the thrombosis. Four days later, he developed pulmonary hemorrhage, had an extended period of low oxygenation and hypotension with acute respiratory distress syndrome, and had to be ventilated for a prolonged period. Follow-up MRI showed evidence of extensive bilateral cortical hypointensities possibly due to hypoxemia. At the last follow-up, he continued to be grossly neurologically impaired. CONCLUSION: Thrombosis of the dural sinuses is a very rare occurrence after an extensive craniotomy and cranial reconstruction. However, it should be considered during the postoperative period and, if diagnosed, it should be treated with anticoagulants. Avoiding a direct sinus injury during reflection of the craniotomy flap and covering the exposed sinus with moist cottonoids during the surgery is advocated to prevent sinus thrombosis.
Asunto(s)
Craneosinostosis/cirugía , Craneotomía/efectos adversos , Trombosis del Seno Lateral/etiología , Anticoagulantes/uso terapéutico , Preescolar , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Complicaciones Intraoperatorias , Trombosis del Seno Lateral/tratamiento farmacológico , Masculino , Complicaciones Posoperatorias , Senos Transversos/lesionesRESUMEN
This is a case report of a 30-year-old female, who presented to the emergency department with headache, nausea and neck pain after five days of otitis media. After lumbar puncture, CT and MRI the patient was treated for meningitis with initial improvement in the clinical state. After four days she developed contralateral neurological symptoms, and after five days she had a seizure. MR-venography showed thrombosis of the lateral dural sinus with venous cerebral infarction. The treatment of intravenously administered antibiotics, mastoidectomy and anticoagulation is discussed and compared with other cases in the literature.
Asunto(s)
Infarto Cerebral/etiología , Trombosis del Seno Lateral/etiología , Otitis Media/complicaciones , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/tratamiento farmacológico , Femenino , Humanos , Trombosis del Seno Lateral/diagnóstico por imagen , Trombosis del Seno Lateral/tratamiento farmacológico , Angiografía por Resonancia Magnética , Mastoidectomía , Meningitis Bacterianas/diagnóstico por imagen , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/etiología , Otitis Media/tratamiento farmacológicoRESUMEN
PURPOSE: Susceptibility-weighted imaging (SWI) visualizes small cerebral veins with high sensitivity and could, thus, enable quantification of hemodynamics of deep medullary veins. We aimed to evaluate volume changes of deep medullary veins in patients with acute cerebral venous sinus thrombosis (CVST) over time in comparison to healthy controls. METHODS: All magnetic resonance imaging (MRI) experiments were executed at 3 T using a 32-channel head coil. Based on SWI and semiautomatic postprocessing (statistical parametric mapping [SPM8] and ANTs), the volume of deep medullary veins was quantified in 14 patients with acute CVST at baseline and the 6month follow-up, as well as in 13 healthy controls undergoing repeated MRI examination with an interscan interval of at least 1 month. RESULTS: Deep medullary venous volume change over time was significantly different between healthy controls and patient groups (p < 0.001). Patients with superior sagittal sinus thrombosis (SSST) showed a significant decline from baseline to follow-up measurements (9.8 ± 4.9 ml versus 7.5 ± 4.2 ml; p = 0.02), whereas in patients with transverse sinus thrombosis (TST) and healthy controls no significant volume changes were observable. CONCLUSIONS: Venous volume quantification was feasible and reproducible both in healthy volunteers and in patients. The decrease of venous volume in patients over time represents improvement of venous drainage, reduction of congestion, and normalization of microcirculation due to treatment. Thus, quantification of venous microcirculation could be valuable for estimation of prognosis and guidance of CVST therapy in the future.
Asunto(s)
Volumen Sanguíneo/fisiología , Venas Cerebrales/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Angiografía por Resonancia Magnética/métodos , Bulbo Raquídeo/irrigación sanguínea , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Enfermedad Aguda , Anticoagulantes/uso terapéutico , Volumen Sanguíneo/efectos de los fármacos , Venas Cerebrales/efectos de los fármacos , Estudios de Cohortes , Estudios de Factibilidad , Femenino , Humanos , Trombosis del Seno Lateral/diagnóstico por imagen , Trombosis del Seno Lateral/tratamiento farmacológico , Modelos Lineales , Estudios Longitudinales , Masculino , Estudios Prospectivos , Valores de Referencia , Reproducibilidad de los Resultados , Trombosis del Seno Sagital/diagnóstico por imagen , Trombosis del Seno Sagital/tratamiento farmacológico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Adulto JovenAsunto(s)
Trombosis del Seno Lateral/complicaciones , Prosopagnosia/etiología , Adulto , Femenino , Cefalea/etiología , Humanos , Trombosis del Seno Lateral/diagnóstico por imagen , Trombosis del Seno Lateral/tratamiento farmacológico , Imagen por Resonancia Magnética , Persona de Mediana Edad , Lóbulo Temporal/fisiopatologíaRESUMEN
BACKGROUND: The complications of otitis media (intra-cranial and extra-cranial) used to have a high morbidity and mortality in the pre-antibiotic era, but these are now relatively rare, mainly due to the use of antibiotics and the use of ventilation tubes, reducing the incidence of such complications significantly. Currently, an early suspicion of these complications is a major challenge for diagnosis and management. CLINICAL CASES: The cases of 5 patients (all male) are presented, who were diagnosed with complicated otitis media, 80% (4) with a mean age of 34.6 years (17-52). There was major comorbidity in 60% (3), with one patient with diabetes mellitus type 2, and two with chronic renal failure. There were 3 (60%) intra-cranial complications: one patient with thrombosis of the sigmoid sinus and a cerebellar abscess; another with a retroauricular and brain abscess, and a third with meningitis. Of the 2 (40%) extra-cranial complications: one patient had a Bezold abscess, and the other with a soft tissue abscess and petrositis. All patients were managed with surgery and antibiotic therapy, with 100% survival (5), and with no neurological sequelae. The clinical course of otitis media is usually short, limiting the infection process in the majority of patients due to the immune response and sensitivity of the microbe to the antibiotic used. However, a small number of patients (1-5%) may develop complications. CONCLUSION: Otitis media is a common disease in our country, complications are rare, but should be suspected when the picture is of torpid evolution with clinical worsening and manifestation of neurological signs.
Asunto(s)
Absceso Encefálico/etiología , Trombosis del Seno Lateral/etiología , Mastoiditis/etiología , Meningitis/etiología , Otitis Media/complicaciones , Petrositis/etiología , Adolescente , Adulto , Antibacterianos/uso terapéutico , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Descompresión Quirúrgica , Diabetes Mellitus Tipo 2/complicaciones , Drenaje , Quimioterapia Combinada , Humanos , Fallo Renal Crónico/complicaciones , Trombosis del Seno Lateral/diagnóstico por imagen , Trombosis del Seno Lateral/tratamiento farmacológico , Trombosis del Seno Lateral/cirugía , Masculino , Mastoiditis/diagnóstico por imagen , Mastoiditis/tratamiento farmacológico , Mastoiditis/cirugía , Meningitis/diagnóstico por imagen , Meningitis/tratamiento farmacológico , Meningitis/cirugía , Persona de Mediana Edad , Otitis Media/tratamiento farmacológico , Otitis Media/cirugía , Petrositis/diagnóstico por imagen , Petrositis/tratamiento farmacológico , Petrositis/cirugía , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: Otogenic paediatric cerebral venous sinus thrombosis (CVST) is rare but has potential clinical sequelae. Its management has long been debated mainly concerning the role of surgery and the use of anticoagulant therapy. OBJECTIVE OF REVIEW: To review the current literature and examine the medical and surgical management of paediatric otogenic CVST and its clinical and radiological outcome. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: The electronic databases (MEDLINE, EMBASE, Cochrane) were searched from inception to November 2014 using text words 'cerebral venous sinus thrombosis OR cerebral venous thrombosis OR lateral sinus thrombosis OR sigmoid sinus thrombosis' AND 'otogenic OR mastoiditis OR otitis media' AND 'children OR paediatric OR pediatric'. EVALUATION METHOD: Inclusion criteria were applied by two reviewers and data extraction was carried out. The type of otological surgery (conservative versus extensive) and the use of anticoagulants with their clinical and radiological outcomes were tabulated. RESULTS: Thirty-six studies (15 case reports and 21 case series) were included with a total of 190 patients. A total of 92.1% of patients underwent otological surgery, and 69.5% had conservative surgery and 30.5% extensive otological surgery. Anticoagulants were used in 59%. A total of 79.2% of patients were reported to have had a good clinical outcome. Within this group, 56% had conservative surgery and anticoagulants. Follow-up scans were documented in 61.6% of patients and complete recanalisation was observed in 51%. Complete recanalisation was observed in 47% of those who had been anticoagulated and 55% of those who received no anticoagulation. CONCLUSIONS: Conservative otological surgery with the combination of anticoagulation was the most common treatment modality found in the group of patients with good clinical outcome. However, given the current low level of evidence, a multicentre collaborative study is needed to help establish the optimum surgical approach and the role of anticoagulation in managing paediatric otogenic CVST.
Asunto(s)
Anticoagulantes/uso terapéutico , Manejo de la Enfermedad , Trombosis del Seno Lateral/tratamiento farmacológico , Otitis Media/complicaciones , Humanos , Trombosis del Seno Lateral/etiologíaRESUMEN
The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.
Asunto(s)
Trombosis del Seno Lateral/etiología , Sinusitis del Esfenoides/complicaciones , Enfermedad Aguda , Adolescente , Humanos , Trombosis del Seno Lateral/tratamiento farmacológico , Masculino , Meningitis Neumocócica/tratamiento farmacológico , Meningitis Neumocócica/etiología , Sinusitis del Esfenoides/terapiaAsunto(s)
Hemorragia Cerebral/etiología , Hidrocefalia/etiología , Malformaciones Arteriovenosas Intracraneales/complicaciones , Trombosis del Seno Lateral/etiología , Adulto , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Cerebelo/irrigación sanguínea , Hemorragia Cerebral/cirugía , Coma/etiología , Anticonceptivos Hormonales Orales/efectos adversos , Descompresión Quirúrgica , Drenaje , Resultado Fatal , Femenino , Hematoma/etiología , Hematoma/cirugía , Heparina/administración & dosificación , Heparina/uso terapéutico , Humanos , Hidrocefalia/cirugía , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Trombosis del Seno Lateral/tratamiento farmacológico , Rotura Espontánea , Fumar/efectos adversosRESUMEN
AIM: This article focuses on the lateral sinus thrombophlebitis, which is a serious complication of the supurated otopathies. MATERIAL AND METHODS: It is based on a study of a significant number of both exo- and endocranial complications treated in the the "Sf Spiridon" Hospital- ORL department and at the "Prof. dr. N. Oblu"- Neurosurgery department (57 out of 251 cases admitted in the past 5 years). RESULTS: Among the 57 cases, there were 8 lateral sinus thrombophlebitis, as well as 6 cases where meningitis coexisted with other endocranial complications, such as lateral sinus thrombophlebitis or brain abscess. The article contains details about some cases with special problems of diagnostic and treatment. CONCLUSIONS: The symptoms of the presented cases are completely different from the common symptomatology. However, the diagnostic of such cases is possible due to the modern imaging methods as well. The lateral sinus thrombophlebitis is usually determined by different causes, one of them being the misuse of the antibiotics (class and daily/total dose). When endocranial complications occur the symptoms of the meningitis are masking the symptoms of other complications. Even if the CT scan or MRI exams performed right on the patient's admission show no other complications, the patient should be followed for a period of 15 up to 30 days after the treatment of the meningitis, by repeating imaging tests to identify a possible complication.
Asunto(s)
Trombosis del Seno Lateral/diagnóstico , Trombosis del Seno Lateral/terapia , Adulto , Antibacterianos/uso terapéutico , Niño , Humanos , Trombosis del Seno Lateral/diagnóstico por imagen , Trombosis del Seno Lateral/tratamiento farmacológico , Trombosis del Seno Lateral/etiología , Trombosis del Seno Lateral/cirugía , Angiografía por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The aim of this study is to report the first case of simultaneous appearance of cerebral venous thrombosis (CVT) and bilateral subdural hematomas (SDHs) following epidural analgesia for labor and delivery and to point out the difficulty of establishing such a diagnosis in the presence of postpartum headache. A 26-year old primigravida with a history of epilepsy received epidural analgesia for delivery. Three days after the uneventful spontaneous vaginal delivery she complained about the headache. Patient responded very well to the pain medication and oral hydration, and the headache was relieved. Ten days after the delivery, the headache reoccurred, and an epidural blood patch was performed that successfully relieved her symptom. Stronger progressive headache with nausea reappeared two days later and the parturient was readmitted to hospital. Urgent neuroimaging examinations detected CVT of right the transverse sinus, ipsilateral cortical veins, and partially occluded superior sagittal sinus, as well as bilateral subacute/chronic SDHs. The treatment of the patient with low molecular weight heparin and antiaggregation therapy was effective. In this case, the diagnosis was delayed because of atypical clinical presentation and potentially confounding events (epidural analgesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. Otherwise, unrecognized intracranial complications and delay of appropriate therapy could be life-threatening.
Asunto(s)
Hematoma Subdural/diagnóstico , Trombosis del Seno Lateral/diagnóstico , Complicaciones del Trabajo de Parto/diagnóstico , Trombosis del Seno Sagital/diagnóstico , Trombosis de la Vena/diagnóstico , Adulto , Analgesia Epidural , Femenino , Cefalea/etiología , Hematoma Subdural/complicaciones , Hematoma Subdural/tratamiento farmacológico , Humanos , Trombosis del Seno Lateral/complicaciones , Trombosis del Seno Lateral/tratamiento farmacológico , Periodo Posparto , Embarazo , Trombosis del Seno Sagital/complicaciones , Trombosis del Seno Sagital/tratamiento farmacológico , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
A case of transverse sinus thrombosis is described in an adolescent male with antecedent meningomyelocele corrected by surgery, and ventriculo-peritoneal derivation. Four months before the occurrence of thrombosis, he presented with bilateral otitis media and mastoiditis, and was treated with antibiotic. Magnetic resonance images were not obtained before referral to our hospital. The patient received full anticoagulation and his clinical course was uneventful. He remains asymptomatic under outpatient surveillance till this report. The aim of reporting the case is to emphasize the role of otologic infections in the origin of intracranial thrombotic phenomena, and highlights the findings of magnetic resonance venography for characterization of intracranial sinus thrombosis.
Asunto(s)
Trombosis del Seno Lateral/diagnóstico , Mastoiditis/complicaciones , Otitis Media/complicaciones , Adolescente , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Humanos , Trombosis del Seno Lateral/tratamiento farmacológico , Trombosis del Seno Lateral/etiología , Angiografía por Resonancia Magnética , Masculino , Mastoiditis/tratamiento farmacológico , Otitis Media/tratamiento farmacológico , Flebografía , Resultado del TratamientoRESUMEN
A retrospective study was undertaken to review the clinical presentation, evaluation, management, and outcome of otogenic lateral sinus thrombosis (LST) in children. All pediatric patients with LST seen in our department between 1999 and 2007 were included; there were 9 cases involving 6 boys and 3 girls whose ages ranged from 8 to 12 years. They had all been treated with antibiotics elsewhere prior to admission, and the duration of symptoms before admission ranged from 5 to 18 days. The most common presenting symptoms were ear discharge, headache, otalgia, and fever. Radiologic evaluation included computed tomography and magnetic resonance imaging. All patients underwent radical mastoidectomy with incision of the lateral sinus and removal of its content. There were no deaths. Pseudomonas and Proteus spp were the most commonly identified organisms. Otogenic LST still poses a serious threat that warrants immediate attention and care. It is often associated with other intracranial complications, such as cerebellar abscess. Computed tomography and magnetic resonance imaging play an important role in the management of this disease. Early and aggressive surgical intervention of this otogenic complication can potentially minimize mortality.
Asunto(s)
Antibacterianos/uso terapéutico , Trombosis del Seno Lateral/cirugía , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Trombosis del Seno Lateral/diagnóstico , Trombosis del Seno Lateral/tratamiento farmacológico , Trombosis del Seno Lateral/patología , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVES: To report the success of anticoagulation (AC) treatment in a case of cerebral venous thrombosis (CVT) with subarachnoid hemorrhage (SAH) in view of the limited evidence seen in the literature supporting such a treatment option. CLINICAL PRESENTATION AND INTERVENTION: A 38-year-old lady with CVT and SAH presented 12 h after the onset of symptoms. AC with low-molecular-weight heparin was started 4 days later, when the repeated brain CT showed regression of the SAH. Heparin was changed to warfarin, and she was asymptomatic over a 12-month follow-up period. DISCUSSION: In a limited number of small studies, AC has been found to be beneficial for cases of CVT with hemorrhagic complications. The proper time to start AC in such cases was not clearly defined, and a delay of 4-33 days was observed after the onset of symptoms. In cases of spontaneous intracranial hemorrhage (ICH) in general, active bleeding is usually confined to the first 6 h, and chances of hematoma enlargement are higher in the first 24 h. On the other hand, it has been advised to rule out a coincidental vascular malformation and to radiologically confirm regression (or at least non-progression) of the ICH before starting AC. CONCLUSION: AC for cases of CVT may remain beneficial in the presence of SAH. The time to start AC for CVT with hemorrhagic complications is unclear; however, AC was successful when given 4 days after the onset of symptoms in our case. It may be wise to repeat CT after at least 24 h from the onset of symptoms (to confirm regression or at least non-progression of the ICH) before starting AC. It may also be prudent to perform magnetic resonance angiography, or digital subtraction angiography to rule out a coincidental intracranial aneurysm before AC.
Asunto(s)
Enoxaparina/uso terapéutico , Fibrinolíticos/uso terapéutico , Trombosis del Seno Lateral/complicaciones , Trombosis del Seno Lateral/tratamiento farmacológico , Hemorragia Subaracnoidea/complicaciones , Trombosis de la Vena/tratamiento farmacológico , Adulto , Femenino , Humanos , Angiografía por Resonancia Magnética , Trombosis de la Vena/complicacionesRESUMEN
Whilst cerebral vascular disease and mental illness in the post-partum period are well recognised, their co-existence and the concept of organic psychoses in pregnancy, parturition and the puerperium remains poorly appreciated (Brockington 2006; Brockington Arch Women's Ment Health 10: 177-178, 2007a; Brockington Arch Women's Ment Health 10: 305-306, b). We report a woman who was referred to the Medical team on-call with a mixed presentation of euphoria, mutism and aggressive behaviour but ultimately demonstrated to have a transverse sinus thrombosis and recovered well with anti-coagulation. This serves an important reminder of the implications of a missed medical diagnosis in this high-risk and vulnerable group of patients.
Asunto(s)
Cefalea/etiología , Trombosis del Seno Lateral/diagnóstico , Trastornos Psicóticos/etiología , Trastornos Puerperales/etiología , Adulto , Anticoagulantes/uso terapéutico , Diagnóstico Diferencial , Femenino , Heparina/uso terapéutico , Humanos , Trombosis del Seno Lateral/complicaciones , Trombosis del Seno Lateral/tratamiento farmacológico , Angiografía por Resonancia Magnética , Periodo Posparto , Embarazo , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/diagnóstico , Trastornos Puerperales/diagnóstico , Resultado del TratamientoRESUMEN
A 16-year-old girl was diagnosed with widely distributed dural sinus thrombosis (DST) and a haemorrhagic infarct in the left parietal lobe. Despite of heparin treatment, pronounced aggravation of symptoms was observed. Through a femoral vein approach a micro-catheter was advanced into the superior sagittal sinus and rt-PA was infused slowly, directly into the thrombus over 24 hours. A follow up angiogram showed recanalisation of sinus. The patient recovered almost completely, with only few remaining cognitive symptoms. This treatment remains experimental, but should be kept in mind for DST-patients unresponsive to heparin treatment.
Asunto(s)
Fibrinolíticos/administración & dosificación , Trombosis del Seno Lateral/tratamiento farmacológico , Trombosis del Seno Sagital/tratamiento farmacológico , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/administración & dosificación , Trombosis de la Vena/tratamiento farmacológico , Adolescente , Cateterismo , Anticonceptivos Orales/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intralesiones , Trombosis del Seno Lateral/inducido químicamente , Trombosis del Seno Lateral/diagnóstico por imagen , Radiografía , Trombosis del Seno Sagital/inducido químicamente , Trombosis del Seno Sagital/diagnóstico por imagen , Seno Sagital Superior , Resultado del Tratamiento , Trombosis de la Vena/inducido químicamente , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Nonseptic lateral sinus thrombosis differs from septic lateral sinus thrombosis in that it is not associated with ear or sinus infection. Mastoid changes are frequently detected on computed tomography or magnetic resonance imaging in cases of nonseptic lateral sinus thrombosis. An otolaryngologic evaluation is usually required to exclude coexisting mastoiditis.
Asunto(s)
Anticoagulantes/uso terapéutico , Trombosis del Seno Lateral/diagnóstico , Trombosis del Seno Lateral/tratamiento farmacológico , Imagen por Resonancia Magnética , Diplopía/diagnóstico , Diplopía/etiología , Estudios de Seguimiento , Cefalea/diagnóstico , Cefalea/etiología , Humanos , Venas Yugulares/diagnóstico por imagen , Trombosis del Seno Lateral/complicaciones , Masculino , Mastoiditis/diagnóstico , Otolaringología/métodos , Flebografía/métodos , Rol del Médico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
CONCLUSIONS: Otogenic lateral sinus thrombosis (OLST) is almost always associated with other complications of chronic otitis media (COM) and did not present a distinct clinical expression. In our experience, OLST exhibits a benign course if the underlying disease is controlled. Mastoidectomy in combination with broad-spectrum antibiotics provided effective treatment. Anticoagulation therapy is no longer used routinely. Recanalization is rare and is independent of the use of anticoagulants. OBJECTIVES: This study aimed to contribute to the understanding of the clinical aspects and evolution of OLST. PATIENTS AND METHODS: The study investigated a retrospective case series in a tertiary teaching hospital. From 1993 to 2007, eight cases of OLST were treated. The clinical and imaging data, treatments, and outcomes were analyzed. The follow-up period ranged from a minimum of 6 months to 5 years. RESULTS: In all eight patients, the lateral sinus thrombosis was detected by imaging studies performed to evaluate complications and symptoms related to COM. Fever, headache, and cranial nerve paralysis were the main clinical manifestations associated with coexisting mastoiditis, meningitis, and cerebellar and epidural abscess. We could not identify features specific to lateral sinus thrombosis in any case. All patients underwent mastoidectomy and were given broad-spectrum antibiotics for 2 months. Four cases were anticoagulated and all eight cases experienced complete clinical recovery without sequelae.
Asunto(s)
Colesteatoma del Oído Medio/complicaciones , Enterococcus , Infecciones por Bacterias Grampositivas/complicaciones , Trombosis del Seno Lateral/diagnóstico , Mastoiditis/diagnóstico , Otitis Media/complicaciones , Infecciones por Proteus/complicaciones , Proteus mirabilis , Infecciones por Pseudomonas/complicaciones , Adulto , Antibacterianos/administración & dosificación , Anticoagulantes/administración & dosificación , Cefalosporinas/administración & dosificación , Colesteatoma del Oído Medio/cirugía , Enfermedad Crónica , Terapia Combinada , Comorbilidad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/cirugía , Heparina/administración & dosificación , Hospitales de Enseñanza , Humanos , Trombosis del Seno Lateral/tratamiento farmacológico , Trombosis del Seno Lateral/etiología , Trombosis del Seno Lateral/cirugía , Angiografía por Resonancia Magnética , Masculino , Apófisis Mastoides/cirugía , Mastoiditis/tratamiento farmacológico , Mastoiditis/etiología , Mastoiditis/cirugía , Examen Neurológico , Otitis Media/tratamiento farmacológico , Otitis Media/cirugía , Infecciones por Proteus/tratamiento farmacológico , Infecciones por Proteus/cirugía , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
The purposes of this study were to review the clinical characteristics and treatment outcomes of patients with lateral sinus thrombosis (LST) and to discuss the need of internal jugular vein (IJV) ligation or anticoagulants. We retrospectively reviewed the charts of five patients (1 male and 4 female) with LST. The chief complaints were otalgia, fever, mastoid tenderness, and neck pain. All patients were confirmatively diagnosed with MRI-Venography or Angio-CT scans. The patients were treated with appropriate antibiotics and operations including mastoidectomies with/without thrombectomy according to their suspected disease course. The authors did not perform IJV ligation and use anticoagulants in all cases, but there were no mortalities or morbidities. IJV ligation and use of anticoagulants do not seem to be essential procedures for the management of LST, and it should be considered carefully according to the extents of disease and the state of patients.
Asunto(s)
Anticoagulantes/administración & dosificación , Venas Yugulares/efectos de los fármacos , Venas Yugulares/cirugía , Trombosis del Seno Lateral/tratamiento farmacológico , Trombosis del Seno Lateral/cirugía , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Humanos , Trombosis del Seno Lateral/diagnóstico , Ligadura/métodos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Flebografía , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: Our review aims: (1) to highlight the suspicion of lateral sinus thrombosis (LST) following a minor head injury in the pediatric population; (2) to discuss the different etiologies of lateral sinus thrombosis; (3) to identify an exact mechanism of the thrombus formation; (4) to clarify the role of each diagnostic tool; (5) to implement an algorithm for the treatment of LST due to a minor head injury. METHOD: We performed a MEDLINE search for LST following a minor head trauma related articles that were published between 1950 and June 2008. We identified 19 related studies of which 22 patient records were noted. We also added our case to this series. The information from the reports was analyzed to characterize the clinical aspects, the radiologic findings, the treatment, the follow-up, and the management of this disease. RESULTS: Twenty-three cases (20 pediatrics and 3 adults) of LST following a minor head trauma have been published including the new one presented here. The mean pediatric age in this series is 7.8 years. There were 11 cases on the right side and 8 on the left side. Male to female ratio is 1.4:1. Side and sex were not reported in 4 and 6 cases, respectively. Sigmoid and transverse sinuses were the most affected one. Eighty-three percent were treated by observation while the remaining 17% received anticoagulation. The outcome was good in all patients without any notable major complications. The radiological investigation showed that there was a complete recanalization in 9 patients and a partial recanalization in 3 patients with a mean time of 8.3 weeks. CONCLUSION: Lateral sinus thrombosis seldomly occurs following a minor head injury. This entity is difficult to diagnose and one should exercise a high degree of suspicion when confronted with an ambiguous neurological status following a closed head trauma. The most accurate imaging test according to our experience is a multiple detector row computerized tomography (MDCT) venography completed at the time of the presentation. The indication to proceed with an MRI has to be assessed on a case-by-case basis. Anticoagulation is reserved for patients presenting a papilledema or for patients complaining of persistent headaches, vomiting, or disequilibrium.