Cerebral venous sinus thrombosis and intracranial hemorrhage: a rare but classic complication of otorhinolaryngology infections

Excerpt

A 23-year-old man presented to the emergency department with a 3-day history of fever, headaches, and vomiting. Ten days earlier, he was successively treated for an acute otitis media, with antibiotics, corticosteroid, and nonsteroidal anti-inflammatory. Admission Glasgow Coma Score was 13. The patient had febrile meningeal syndrome and a left lateral homonymous hemianopsia. Brain MRI showed a right parieto-occipital intraparenchymal hemorrhage and an extensive cerebral venous thrombosis (CVT) from right lateral sinus to internal jugular vein associated with a right mastoiditis (Fig. 1). Cerebrospinal fluid (CSF) analysis showed pleiocytosis, increased protein concentration (3 g L⁻¹), depressed glucose concentration, and a high lactic acid level (4.3 mmol L⁻¹). Culture was negative, because of early antibiotic treatment. Thrombophilia screening was negative. Successful treatment included antibiotics (cefotaxime 200 mg kg⁻¹ day⁻¹ for 4 weeks), anticoagulation (heparin followed by vitamin K antagonist, VKA), right tympanocentesis, and antiepileptics. The patient was discharged to rehabilitation after 2 months.

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