Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review
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(2020) 46:122
CASE REPORT
Open Access
Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review Massimo Luca Castellazzi1, Giada Maria di Pietro2, Michele Gaffuri3, Sara Torretta3, Giorgio Conte4, Francesco Folino2, Sebastiano Aleo5, Samantha Bosis5* and Paola Marchisio5,6
Abstract Background: Cerebral venous sinus thrombosis in children is a rare but potentially fatal complication of acute mastoiditis, one of the most common pediatric infectious diseases. Due to its subtle clinical presentation, suspicion is essential for a prompt diagnosis and appropriate management. Unfortunately, no standard treatment options are available. To discuss the possible clinical presentation, microbiology, and management, we here report the case of a child with otogenic cerebral venous sinus thrombosis and perform a literature review starting from 2011. Case presentation: The child, a 10-months-old male, presented clinical signs of right acute otitis media and mastoiditis. Brain computed tomography scan detected right sigmoid and transverse sinus thrombosis, as well as a subperiosteal abscess. Fusobacterium necrophorum and Haemophilus Influentiae were detected on cultural sampling. A multidisciplinary approach along with a combination of medical and surgical therapy allowed the patient’s full recovery. Conclusion: Cerebral venous sinus thrombosis is a rare but severe complication of acute otitis media and mastoiditis. The management of this pathological condition is always challenging and an interdisciplinary approach is frequently required. Current therapeutic options include a combination of medical and surgical therapy. A patient-centered approach should guide timing and treatment management. Keywords: Acute otitis media, Acute mastoiditis, Cerebral venous sinus thrombosis, Fusobacterium necrophorum, Children
Background Acute otitis media (AOM) is one of the most common infectious diseases in the pediatric age group, with at least 60% of children under the age of 3 having experienced at least one episode, and approximately 24% three or more episodes [1]. The most frequent AOM complication is acute mastoiditis (AM); more severe complications such as facial paralysis, meningitis, subperiosteal, epidural, or intracerebral are still possible albeit rare [2]. * Correspondence: [email protected] 5 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy Full list of author information is available at the end of the article
Cerebral venous sinus thrombosis (CVST) is a possible severe complication of AM, with an estimated incidence rate of 0–2.7% [3]. It has been associated with neurological sequelae and is potentially fatal if not promptly diagnosed and treated [4]. Specific management of the condition, however, is still a matter of debate [5, 6].
Case presentation A previously healthy 10-months-old patient was admitted to the pediatric emergency department of our hospital with a two-day long fever, irritability and right otorrhea
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