Cerebral venous thrombosis following acute otitis media

Abstract

Introduction: Cerebral venous thrombosis (CVT) as a complication of acute otitis media (AOM) has a very low incidence, making it an uncommon cause of intracranial hypertension (ICH).

Clinical case: A 3-year-old child who, after ten days from the diagnosis of right AOM, presented with sudden severe headache and right sixth cranial nerve palsy. The clinical suspicion of ICH was confirmed by the finding of bilateral papilledema and increased cerebrospinal fluid opening pressure (24 cmH₂O), following a normal cranial CT scan. Further studies included cranial magnetic resonance angiography (MRA), showing thrombosis of the right transverse and sigmoid sinuses extending to the internal jugular vein, along with right mastoiditis. Intravenous antibiotic therapy and enoxaparin were initiated. Due to persistent ICH, treatment with acetazolamide was started and continued for three months until complete resolution of symptoms and confirmed repermeabilization on follow-up MRA.

Comments: In suspected ICH, ophthalmologic evaluation, neuroimaging, and, if normal, lumbar puncture with measurement of opening pressure should be performed. A rare cause of ICH is CVT secondary to AOM, which requires early treatment and multidisciplinary management.