Lateral sinus thrombosis patient presenting with headache and vomiting

Abstract

Lateral sinus thrombosis is rare intracranial complications of otitis media. A 12 years old girl patient presented with complaints of vomiting and headeche. Patient treated with ceftriaxone had lost seven kilograms in ten days. There were complaints of frequent upper way infection and otitis media. Physical examination of right ear was painful and right tympanic membrane was pale. Laboratory tests shuch as hemogram, blood smear, Brucella tube agglütination test, biochemistry tests, abdomen ultrasaund and chest X-ray were all normal. Besides a CRP was 65 mg/L and sedimantation rate was 26 mm/h. PT and PTT values were 15,1 and 29,8s respectively, fibrinogen was 280 mg/dl. In urine analysis +3 keton bodies were observed. Homosistein level was normal, MTFHR gene polymorphism was heterozigot A1298C. Magnetic resonance imaging (MRI) showed right chronic otitis media and thrombosis in both lateral and sigmoid sinuses. She was treated mastoidectomy and concurrent middle ear ventilation tubes. Enoxaparin was also started in postoperative treatment. Intracranial problems must be rapidly evaluated in patients with headache and vomiting. In this study we aimed to emphasize that lateral sinus thrombosis has to be taken into consideration in patients complainig intracranial problems with headache and vomiting.

Keywords

• Otitis media, lateral sinus thrombosis, headache, vomiting.

Başağrısı ve kusma ile başvuran lateral sinus trombozu olgusu

Abstract

Lateral sinus trombozu otitis medianın nadir intrakranial komplikasyonlarından biridir. Kusma ve baş ağrısı ile başvuran 12 yaşında kız hastanın yaklaşık on gündür devam eden şikayetlerinin yedi kilogram kayba neden olduğu, altı gün seftriakson enjeksiyonu yapıldığı, sık üst solunum yolu enfeksiyonu ve orta kulak iltihabı geçirdiği öğrenildi. Fizik muayenesinde; sağ dış kulak yolu muayenede ağrılı, sağ kulak zarı mat idi. Laboratuar incelemesinde hemogram, periferik yayma, kan biyokimyası, brusella tüp aglütinasyon testi, batın ultrasonu ve akciğer grafisi normal olarak tespit edildi. CRP 65 mg/L, sedimantasyon 26 mm/sa, PT:15,1 sn, PTT: 29,8 sn, fibrinojen 280 mg/dl, idrar tahlilinde 3+ keton mevcut idi. Homosistein seviyesi normal, MTFHR A1298C heterozigot tespit edildi.Yapılan MR incelemede sağda kronik otitis media ile uyumlu değişiklikler, sağ lateral ve sigmoid sinüste tromboz tespit edildi. Hastaya sağ timpanomasteidektomi yapıldı, ventilasyon tüpü takıldı ve postoperatif enoxaparin başlandı. Dirençli kusma ve başağrısı olan hastada intrakranial nedenlerin hızlı bir şekilde değerlendirilmesi gerekmektedir. Biz bu vakada kronik otitis medianın nadir bir komplikasyonu olan lateral sinus trombozunun intrakranial nedenler arasında düşünülmesi gerektiğini vurgulamayı amaçladık.

Keywords

• Otitis media, lateral sinüs trombozu, baş ağrısı, kusma

References

1. Long E, Pitfield AF, Kissoon N. Anticoagulation therapy, indications, monitoring, and complications. Pediatr Emerg Care 2011;27:55-61.
2. Gökçe M, Tatlı B, Aydınlı N, ve ark. Akut venöz sinüs trombozunda çoklu etyoloji. Türk Pediatri Arşivi 2005;40:46-49.
3. Isaacson B, Miribal C, Kurtz Jr JW, Roland PS. Pediatric otogenic intracranial abscesses. Otolaryngol Head Neck Surg 2010;142:434-437.
4. Shambaugh GE. Surgery of the Ear. Philadelphia; PA: Saunders 1959.
5. Ooi FH, Hilton M, Hunter G. Management of lateral sinus thrombosis: update and literature review. J Laryngol Otol 2003;117:932-939.
6. Speed WF. Lateral sinus thrombosis. Am J Otol 1983;4:258- 262.
7. Bales CB, Sobol S, Wetmore R, Elden LM. Lateral sinus thrombosis as a complication of otitis media: 10-year experience at the children’s hospital of Philadelphia. Pediatrics 2009;123:709-713.
8. Christensen N, Wayman J, Spencer J. Lateral sinus thrombosis: A review of seven cases and proposal of a management algorithm. Int J Pediatr Otorhinolaryngol 2009;73:581-584.

9. Sitton MS, Chun R. Pediatric otogenic lateral sinus thrombosis: Role of anticoagulation and surgery. Int J of Ped Otol 2012;76:428-432.
10. Neilan RE, Isaacson B, Kurtz W, et al. Pediatric otogenic lateral sinus thrombosis recanalization. lnt J Pediatr Otorhinolaryngol 2011;75:850-853.
11. Cumurciuc R, Crassard I, Sarov M, et al. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. J Neurol Neurosurg Psychiatry 2005;76: 1084-1087.
12. Wasay M, Kojan S, D, Bobustuc G, Sheikh Z. Headache in cerebral venous thrombosis incidence, pattern and location in 200 consecutive patients. J Headache Pain 2010;11:137- 139.
13. Bielecki I, Cofala M, Mierzwinski J. Otogenic lateral sinus thrombosis in children. Otol Neurotol 2011;32:1111-1115.
14. Lievers KJA, Boers GHJ, Verhoef V, et al. A second common variant in methylenetetrahydrofolate reductase (MTHFR) gene and its relationship toMTHFR enzyme activity, homocysteine and cardiovascular disease risk. J Mol Med (Berl) 2001;79:522-528.
15. Fodinger M, Horl WH, Sunder-Plassman G. Molecular biology of 5,10-methylenetetrahydrofolate reductase. J Nephrol 2000;13:20-33.
16. Botto LD, Yang Q. 5,10-Methylenetetrahydrofolate reductase gene variants and congenital anomalies: Am J Epidemiol 2000;151:862-877.
17. Szczeklik A, Sanak M, Jankowski M, et al. Mutation A1298C Risk for early coronary disease not associated with hyperhomocysteinemia. Am J Med Genet 2001;101:36-39.
18. Diaz-Arrastia R. Homocysteine and neurologic disease. Arch Neurol 2000;57:1422-1428.
19. Dikmen M, Gülel B, Güneş HV. Akut inme hastalarında risk faktörü olan homosistein düzeyine MTHFR gen polimorfizmlerinin etkisi. Kocatepe Tıp Dergisi 2004;5:55- 61.