Lateral sinus thrombosis: a modern perspective.

At Emory, six cases of lateral sinus thrombosis (LST) were seen over the last ten years--two children and four adults. The picture and bacteriology of LST have changed with the advent of antibiotics as has the usefulness of various diagnostic tests. Less is it a disease of children in association with acute otitis media. More often it is seen in the adult patient after a long history of chronic ear disease. Fever and mastoid and neck tenderness are still universal signs of the affliction. However, rarely patients do present with progressive anemia, emaciation and evidence of septic emboli. Since antibiotics are commonly used during the prodromal ear infection, cultures are often negative. If they do identify an organism, it is usually a mixed flora rather than beta hemolytic streptococcus. Spinal fluid results are variable and seldom is there evidence of increased spinal fluid pressure. Arteriography, venography, and digital subtraction venography are the most reliable tests to prove and delimit the thrombus. Early management involves high dose broad spectrum, intravenous antibiotics including chloramphenicol. Surgical intervention involves a mastoidectomy, exposure of the sinus, incision and drainage, but not necessarily removal of the thrombus. Internal jugular vein ligation should be reserved for those cases in which septicemia and embolization do not respond to initial surgery and intravenous antibiotics.