Cerebral vein and sinus thrombosis--an important cause of benign intracranial pressure increase in childhood

Abstract

The syndrome of raised intracranial pressure without any space-occupying lesion (pseudotumor cerebri) is still of unknown etiology. To some degree, secondary causes can be found. With respect to the therapeutical possibilities, a clinically important cause is the thrombosis of a major cerebral sinus. In children it is sometimes associated with otitis media. However, clinical signs of mastoiditis can be missed because of previous antibiotic treatment. We observed 11 children with pseudotumor cerebri. Four children suffered from an occlusion of a lateral major sinus after otitis media. The treatment with heparin in the acute stage and later on with acetylsalicylic-acid led to complete recovery. Our results suggest that the thrombosis of a major cerebral sinus induced by an otitis media is a frequent cause of pseudotumor cerebri in children and should be excluded by MRI or angiography in any doubtful case. In contrast to the treatment of adults, long term anticoagulation is not necessary.