Skip to main content

Advertisement

SpringerLink
Log in

The management of elevated intracranial pressure and sinus vein thrombosis associated with mastoiditis: the experience of eighteen patients

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bondy J et al (2000) Direct expenditures related to otitis media diagnoses: extrapolations from a pediatric medicaid cohort. Pediatrics 105:E72

    Article  CAS  Google Scholar 

  2. Lavin JM, Rusher T, Shah RK (2016) Complications of pediatric otitis media. Otolaryngol Head Neck Surg 154:366–370

    Article  Google Scholar 

  3. Pang LH, Barakate MS, Havas TE (2009) Mastoiditis in a paediatric population: a review of 11 years experience in management. Int J Pediatr Otorhinolaryngol 73:1520–1524

    Article  Google Scholar 

  4. Finnbogadóttir AF et al (2009) An increasing incidence of mastoiditis in children in Iceland. Scand J Infect Dis 41:95–98

    Article  Google Scholar 

  5. Katz A et al (2003) Acute mastoiditis in Southern Israel: a twelve year retrospective study (1990 through 2001). Pediatr Infect Dis J 22:878–882

    Article  Google Scholar 

  6. Quesnel S et al (2010) Acute mastoiditis in children: a retrospective study of 188 patients. Int J Pediatr Otorhinolaryngol 74:1388–1392

    Article  CAS  Google Scholar 

  7. Groth A et al (2012) Acute mastoiditis in children aged 0–16 years—a national study of 678 cases in Sweden comparing different age groups. Int J Pediatr Otorhinolaryngol 76:1494–1500

    Article  Google Scholar 

  8. Leskinen K (2005) Complications of acute otitis media in children. Curr Allergy Asthma Rep 5:308–312

    Article  Google Scholar 

  9. Zevallos JP et al (2009) Advanced pediatric mastoiditis with and without intracranial complications. Laryngoscope 119:1610–1615

    Article  Google Scholar 

  10. Grant J et al (2013) The role of lumbar puncture and pressure-lowering therapy for transverse dural sinus thrombosis. J Neurosci Rural Pract 4:S106–S108

    Article  Google Scholar 

  11. Palma S et al (2007) Acute mastoiditis in children: the Ferrara experience. Int J Pediatr Otorhinolaryngol 71:1663–1669

    Article  CAS  Google Scholar 

  12. Ghosh PS et al (2011) Lateral sinus thrombosis associated with mastoiditis and otitis media in children: a retrospective chart review and review of the literature. J Child Neurol 26:1000–1004

    Article  Google Scholar 

  13. Ooi EH, Hilton M, Hunter G (2003) Management of lateral sinus thrombosis: update and literature review. J Laryngol Otol 117:932–939

    Article  Google Scholar 

  14. Rollins N et al (2005) Cerebral MR venography in children: comparison of 2D time-of-flight and gadolinium-enhanced 3D gradient-echo techniques. Radiology 235:1011–1017

    Article  Google Scholar 

  15. Singh B (1993) The management of lateral sinus thrombosis. J Laryngol Otol 107:803–808

    Article  CAS  Google Scholar 

  16. Wong I et al (2005) Pediatric lateral sinus thrombosis: retrospective case series and literature review. J Otolaryngol 34:79–85

    Article  Google Scholar 

  17. Billinghurst L, Mahendranath M (2018)  Sinovenous thrombosis in infants and children, in Swaiman’s Pediatric Neurology, S.K. F., Editor 1963–77

  18. Heller C et al (2003) Cerebral venous thrombosis in children: a multifactorial origin. Circulation 108:1362–1367

    Article  Google Scholar 

  19. Kenet G et al (2004) Paediatric cerebral sinus vein thrombosis. A multi-center, case-controlled study. Thromb Haemost 92:713–8

  20. Kenet G et al (2010) Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation 121:1838–1847

    Article  Google Scholar 

  21. Osborn AJ, Blaser S, Papsin BC (2011) Decisions regarding intracranial complications from acute mastoiditis in children. Curr Opin Otolaryngol Head Neck Surg 19:478–485

    Article  Google Scholar 

  22. Avery RA et al (2011) CSF opening pressure in children with optic nerve head edema. Neurology 76:1658–1661

    Article  CAS  Google Scholar 

  23. Avery RA et al (2010) Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 363:891–893

    Article  CAS  Google Scholar 

  24. Swaiman KF (2018) Disorders of intracranial pressure, in Swaiman’s Pediatric Neurology, S.K. F., Editor 1868

  25. Dlamini N, Billinghurst L, Kirkham FJ (2010) Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am 21:511–527

    Article  Google Scholar 

  26. Wasay M et al (2008) Cerebral venous sinus thrombosis in children: a multicenter cohort from the United States. J Child Neurol 23:26–31

    Article  Google Scholar 

  27. Adesina O, Patel BC (2021) Optic nerve decompression. [Updated 12 May 2021]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538300/

  28. Feldon SE (2007) Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension. Neurosurg Focus 23

  29. Banta JT, Farris BK (2000) Pseudotumor cerebri and optic nerve sheath decompression. Ophthalmology 107:1907–1912

    Article  CAS  Google Scholar 

  30. Spitze A, Lam P, Al-Zubidi N, Yalamanchili S, Lee AG (2014) Controversies: optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension. Indian J Ophthalmol 62:1015–1021. https://doi.org/10.4103/0301-4738.146012

    Article  PubMed  PubMed Central  Google Scholar 

  31. Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M et al (2011) Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. American Heart Association Stroke Council and the Council on Epidemiology and Prevention Stroke 42:1158

    PubMed  Google Scholar 

  32. Friedman DI, Jacobson DM (2002) Diagnostic criteria for idiopathic intracranial hypertension. Neurology 59:1492–1495

    Article  Google Scholar 

  33. Wall M (2017) Update on idiopathic intracranial hypertension. Neurol Clin 35:45–57

    Article  Google Scholar 

  34. Loh C, Lightbody K, Donne AJ (2013) The management of the intracranial complications of acute otitis media in children. The Otorhinolaryngologist 6:144–149

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neurology, Bursa Yuksek İhtisas Training and Research Hospital, Yıldırım, Bursa, Turkey, 16310

    Cengiz Havalı

  2. Department of Pediatrics, Division of Neurology, Medical Park Hospital, Samsun, Turkey

    Hülya İnce

  3. Department of Brain and Nerve Surgery, Bursa Yuksek İhtisas Training and Research Hospital, Bursa, Turkey

    Elif Başaran Gündoğdu

  4. Department of Pediatrics, Division of Neurology, Ankara City Hospital, Ankara, Turkey

    Esra Gürkaş

  5. Department of Pediatrics, Division of Neurology, Trakya University School of Medicine, Edirne, Turkey

    Yasemin Karal

  6. Department of Pediatrics, Division of Neurology, Bursa Yuksek İhtisas Training and Research Hospital, Bursa, Turkey

    Arzu Ekici

  7. Department of Otolaryngology, Bursa Anadolu Hospital, Bursa, Turkey

    Ercan Gündoğdu

Authors
  1. Cengiz Havalı
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hülya İnce
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elif Başaran Gündoğdu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Esra Gürkaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasemin Karal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arzu Ekici
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ercan Gündoğdu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cengiz Havalı.

Ethics declarations

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Havalı, C., İnce, H., Gündoğdu, E.B. et al. The management of elevated intracranial pressure and sinus vein thrombosis associated with mastoiditis: the experience of eighteen patients. Childs Nerv Syst 38, 421–428 (2022). https://doi.org/10.1007/s00381-021-05402-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-021-05402-6

Keywords

Search

Navigation