Cengiz Havalı1, Hülya İnce2, Elif Başaran Gündoğdu3, Esra Gürkaş4, Yasemin Karal5, Arzu Ekici6, Ercan Gündoğdu7. 1. Department of Pediatrics, Division of Neurology, Bursa Yuksek İhtisas Training and Research Hospital, Yıldırım, Bursa, Turkey, 16310. cengizhavali@gmail.com. 2. Department of Pediatrics, Division of Neurology, Medical Park Hospital, Samsun, Turkey. 3. Department of Brain and Nerve Surgery, Bursa Yuksek İhtisas Training and Research Hospital, Bursa, Turkey. 4. Department of Pediatrics, Division of Neurology, Ankara City Hospital, Ankara, Turkey. 5. Department of Pediatrics, Division of Neurology, Trakya University School of Medicine, Edirne, Turkey. 6. Department of Pediatrics, Division of Neurology, Bursa Yuksek İhtisas Training and Research Hospital, Bursa, Turkey. 7. Department of Otolaryngology, Bursa Anadolu Hospital, Bursa, Turkey.
Abstract
PURPOSE: Cerebral sinus vein thrombosis (CSVT) associated with acute mastoiditis is a rare complication of acute otitis media. Elevated intracranial pressure (ICP) frequently occurs secondary to CSVT. The study aims to review the 5 years of experience of four medical centres to treat sigmoid sinus thrombosis and elevated intracranial pressure in children. METHODS: Patients with CSVT that developed secondary mastoiditis from 2016 through 2021 were evaluated in four centres from Turkey. Patients diagnosed with a preceding or synchronous mastoiditis and intracranial sinus thrombosis were included in the study. Magnetic resonance imaging (MRI), magnetic resonance venography (MRV), ICP measurements, ophthalmological examinations, thrombophilia studies and treatments for increased ICP have also been recorded. RESULTS: The study group comprises 18 children. Twelve patients were diagnosed with right-sided, six patients with left-sided sinus vein thrombosis. All of the patients had ipsilateral mastoiditis. The most common presenting symptoms were fever, ear pain, headache, visual disorders and vomiting. The most encountered neurologic findings were papilledema, strabismus and sixth cranial nerve palsy. ICP was over 20 cm H2O in eleven patients. Anticoagulant treatment, antibiotics, pressure-lowering lumbar puncture and lumboperitoneal shunt were among the treatment modalities. CONCLUSION: Elevated ICP can damage the brain and optic nerve irreversibly, without treatment. For treating elevation of ICP associated with cerebral sinus thrombosis, pressure-lowering lumbar puncture (LP), acetazolamide therapy, optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF)-shunting procedures are suggested in case of deteriorated vision.
PURPOSE: Cerebral sinus vein thrombosis (CSVT) associated with acute mastoiditis is a rare complication of acute otitis media. Elevated intracranial pressure (ICP) frequently occurs secondary to CSVT. The study aims to review the 5 years of experience of four medical centres to treat sigmoid sinus thrombosis and elevated intracranial pressure in children. METHODS: Patients with CSVT that developed secondary mastoiditis from 2016 through 2021 were evaluated in four centres from Turkey. Patients diagnosed with a preceding or synchronous mastoiditis and intracranial sinus thrombosis were included in the study. Magnetic resonance imaging (MRI), magnetic resonance venography (MRV), ICP measurements, ophthalmological examinations, thrombophilia studies and treatments for increased ICP have also been recorded. RESULTS: The study group comprises 18 children. Twelve patients were diagnosed with right-sided, six patients with left-sided sinus vein thrombosis. All of the patients had ipsilateral mastoiditis. The most common presenting symptoms were fever, ear pain, headache, visual disorders and vomiting. The most encountered neurologic findings were papilledema, strabismus and sixth cranial nerve palsy. ICP was over 20 cm H2O in eleven patients. Anticoagulant treatment, antibiotics, pressure-lowering lumbar puncture and lumboperitoneal shunt were among the treatment modalities. CONCLUSION: Elevated ICP can damage the brain and optic nerve irreversibly, without treatment. For treating elevation of ICP associated with cerebral sinus thrombosis, pressure-lowering lumbar puncture (LP), acetazolamide therapy, optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF)-shunting procedures are suggested in case of deteriorated vision.
Authors: Gustavo Saposnik; Fernando Barinagarrementeria; Robert D Brown; Cheryl D Bushnell; Brett Cucchiara; Mary Cushman; Gabrielle deVeber; Jose M Ferro; Fong Y Tsai Journal: Stroke Date: 2011-02-03 Impact factor: 7.914
Authors: Arielle Spitze; Peter Lam; Nagham Al-Zubidi; Sushma Yalamanchili; Andrew G Lee Journal: Indian J Ophthalmol Date: 2014-10 Impact factor: 1.848