Thrombosis of sigmoid sinus, transverse sinus, and internal jugular vein in chronic otitis media in 9-year-old girl: a case report

Abstract

Introduction and importance: Chronic otitis media can lead to dreadful intracranial complications, the most common being meningitis. A concomitant finding of thrombosis in more than one sinus with a cerebral vein is extremely rare. Septic sigmoid sinus thrombosis has an infectious origin and the treatment is debatable between antibiotics and surgery. Case presentation: A case of 9-year-old female with prolonged symptoms of right sided ear discharge, fever, right sided neck pain, and vomiting. Examination revealed tachycardia and neck rigidity suggesting meningitis. The child developed shock, generalized seizure, and a persistent high grade fever in the course of hospital stay. Brain imaging revealed sigmoid, transverse, and internal jugular thrombosis. Blood culture grew both gram-positive and gram-negative bacteria, suggesting the infectious origin of the thrombus. The authors treated meningitis with cephalosporin and vancomycin at first, and then additional antibiotics to treat the septic sigmoid sinus thrombosis. Clinical discussion: Sigmoid sinus thrombosis is a rare condition caused by infections, thrombophilia, head trauma, some types of cancer, and intravenous drug use. Cerebral vein or sinus thrombosis can lead to raised intracranial pressure and can cause fever, otalgia, headache, vomiting, cranial nerve palsies, papilledema altered mental status and may cause seizures, stupor, and coma. Prompt diagnosis by CT scan or MRI and prompt treatment with antibiotics are crucial. Conclusion: Sigmoid sinus thrombosis with involvement of the transverse sinus and internal jugular vein is a rare complication of chronic otitis media, and should be suspected if a recurring fever with features of raised intracranial pressure is present in a child with chronic otitis media.