Otogenic lateral sinus thrombosis

Abstract

Otogenic lateral sinus thrombosis (LST) occurs as an in­tra­cra­nial complication of otitis media. In the pre­anti­bio­tic era, the mortality was almost 100%. Today, thanks to antibiotics, the rate of mortality dropped at 10%. In the context of chronic otitis media, the infection migrates through bone dehiscence or erosions and causes initially an abs­cess around the lateral sinus, with thrombophlebitis of the venules that surround the external wall of the sinus in the proximity to dura mater, and these will lead to necrosis of the sinus wall, determining the adhesion of fibrin and pla­telets and, finally, forming a mural thrombus, which evolves towards superinfection and sinus occlusion. Parts of the infected thrombus will break off and enter the blood stream, with all the general symptoms and the possible com­pli­ca­tions from it. We present and discuss a case of la­te­ral sinus thrombosis following chronic otitis media in the pandemic context. The particularity of the case is given by the COVID-19 restrictions. In the absence of the antibiotic the­ra­py, due to the pandemic circumstances, the child de­ve­loped a typical form of LST. Knowledge of the clinical ma­ni­fes­ta­tions of “classic” lateral sinus thrombosis facilitated the diagnostic pro­cess. Fortunately, today our patient was able to benefit from powerful broad-spectrum antibiotics which, combined with the surgical treatment, saved his life.