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A 3-year-old boy developed otitis media, mastoiditis, papilledema, sixth nerve palsy, and increased intracranial pressure. The initial diagnosis was idiopathic intracranial hypertension, but doubt about that diagnosis at such a young age led to imaging reevaluation. When the abnormalities from multiple pulse sequences were aggregated with this clinical input, the correct diagnosis of otitic hydrocephalus emerged, allowing prompt implementation of appropriate treatment to avoid the risk of venous stroke.

Objective: To report a case of chronic suppurative otitis media with complications of lateral sinus thrombosis and otitic hydrocephalus and to discuss its clinical manifestations, clinical course, ancillary procedures and management. Methods: Study Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A 35-year-old man was admitted due to intermittent right otorrhea for 20 years and headache for a month. The Glasgow Coma Scale (GCS) score was 12, and mastoidectomy performed on the second hospital day showed cholesteatoma with erosion of the bony covering of the sigmoid sinus with scanty purulent discharge. The GCS improved to 15 few hours post- operatively, however, 24 hours post-operatively, GCS decreased from 15 to 10 and a CT scan showed dilatation of cerebral ventricles and lateral sinus thrombosis which persisted on subsequent imaging studies. His condition deteriorated irreversibly despite a ventriculostomy, and he eventually expired after 3 weeks in the ward. Conclusion: Otitic hydrocephalus due to lateral sinus thrombosis is a serious complication of chronic suppurative otitis media seldom encountered nowadays. In this case, otitic hydrocephalus developed and progressed despite broad spectrum antibiotics, mastoidectomy and a ventricular shunt. This case report underscores the importance of early recognition of warning signs of intracranial complications to institute prompt management.

Otitic hydrocephalus is a rare complication of acute suppurative otitis media. The main symptoms are nausea, vomiting , headache, blurred vision and diplopia. Pathogenetically it is thought to be a complication of acute mastoiditis with lateral (sigmoid) sinus thrombosis causing intracranial hypertension. Diagnosis is suspected upon CT and MRI images, lumbar puncture should be done for confirmation. Treatment includes methods to lower intracranial pressure, surgical treatment of middle ear infection, systemic antibiotic and anticoagulation therapy. We present a 4-year-old boy with otitic hydrocephalus that primarily came for lesion of abducens and oculomotor nerve and headache after treatment of otogenic meningitis. Antromastoidectomy was performed, followed by intravenous antibiotic and anticoagulation therapy. The patient made a fast and complete recovery, the palsy of the eye movement involved nerves recovered completely as well. [ABSTRACT FROM AUTHOR]

In 1991 we proposed that while the syndrome of isolated intracranial hypertension might have many definite and probable causes, it has nonetheless a single unifying pathophysiological mechanism: namely, impairment of cerebrospinal fluid (CSF) reabsorption. For that reason, we also proposed then that it is best described by a single, unifying, inclusive term, namely, pseudotumor cerebri syndrome. Although it appears that there is, as far as nomenclature is concerned, now international agreement, there is as yet no agreement on pathophysiology and classification. Herein we outline our views on these matters and give our reasons. [ABSTRACT FROM AUTHOR]

Abstract: Lateral sinus thrombosis (LST) occurs when a middle ear infection disseminates directly via bone erosion or disseminates indirectly through the venous networks. The petrosquamosal sinus (PSS) is the residual accessory dural sinus connecting intracranial to extracranial drainage. This report describes a case of a patient with persistent PSS running through the mastoid in context of otitic hydrocephalus with LST. To identify PSS, enhanced CT and reconstructed image from CT venography were more useful than MRI. The possibility of persistent PSS running through the mastoid should be considered if LST without marked inflammation and bone erosion is noted. [Copyright &y& Elsevier]

Abstract: Objectives: [1.] To discuss the presentation, work up, and treatment of a series pediatric patients presenting with acute otogenic lateral sinus thrombosis (OLST). [2.] To review the literature in discussing surgical treatment and the role of anticoagulation for sinus thrombosis from complicated otomastoiditis. Study design: Retrospective case series. Methods: Retrospective case series of seven patients with otomastoidits and lateral sinus thrombosis were included in the study. Type of anticoagulation used and both clinical and radiographic outcomes were compared. Pediatric literature review was conducted using PubMed search terms “thrombosis and otitis media and anticoagulation” limited to English. Results: Seven patients presented with acute otomastoiditis with sigmoid sinus thrombosis. Six patients were treated with anticoagulation for 1.5–12months. Six patients underwent myringotomy with tube and 4 patients underwent cortical mastoidectomy without thrombectomy. Six patients had resolution of thrombosis by imaging in less than 6months. Literature review of 19 pts with OLST showed that 95% had mastoidectomy and 84% had myrigotomy with tube. All 19 patients received anticoagulation. Sixteen patients had complete clinical recovery with recanalization or resolution of clot in 3 patients. Conclusions: The treatment of OLST is controversial. Most (23/26) patients had complete clinical recovery despite clot resolution in 9 of the 26 patients. Four patients had bleeding complication with anticoagulation. This series and literature review highlights the controversy of surgery and use of anticoagulation in the treatment of OLST and the need for further investigation. [Copyright &y& Elsevier]

Abstract: Objective: To describe the recovery outcomes in pediatric patients with otogenic lateral sinus and internal jugular vein thrombosis. Methods: An inpatient database from a tertiary care pediatric hospital was queried from 1999 to 2010 for the diagnosis code [325] thrombosis of intracranial venous sinus. Demographics, extent of thrombosis, surgical intervention, use of anticoagulation, and the presence of recanalization on follow-up imaging was collected. Results: Fifteen patients (10 male, 5 female) were identified with otogenic lateral sinus thrombosis. Eleven patients (73.3%) had evidence of thrombus in the transverse sinus, while 10 patients (66.7%) had thrombus in the internal jugular vein, and one patient (6.7%) had thrombus in the cavernous sinus. Five patients (33%) had otitic hydrocephalus. Twelve patients (80%) underwent operative manipulation of the lateral sinus including: three decompressions 20%, three needle aspirations 20%, and six venotomies with evacuation of clot or pus 40%. Twelve patients were anticoagulated with low molecular weight heparin, and three patients were not anticoagulated. Ten of fourteen patients (71.4%) who underwent follow-up magnetic resonance venography had evidence of partial (57.1%) or complete (14.3%) recanalization of the lateral sinus. All five patients with otitic hydrocephalus recovered as determined by a normal fundoscopic exam and recovery of abducens paresis. Conclusion: Recanalization of the lateral intracranial venous sinus occurred in the majority of the patients in this series. The role of operative intervention and/or anticoagulation remains unclear. [Copyright &y& Elsevier]

OBJECTIVES. Lateral sinus thrombosis is a rare intracranial complication of otitis media that is traditionally described in countries with poor access to medical care. Our goal was to describe the clinical presentation, management, and outcome of patients diagnosed with lateral sinus thrombosis in a US tertiary care center and to highlight the clinically relevant differences in presentation between these patients and those described in previous reports. PATIENTS AND METHODS. The medical charts of 13 patients diagnosed with otogenic lateral sinus thrombosis were reviewed. These patients were identified from a manual search of 156 subjects with International Classification of Diseases, Ninth Revision codes corresponding with a diagnosis of mastoiditis or thromboembolism over a 10-year period (1997-2007) at the Children's Hospital of Philadelphia. RESULTS. In contrast to previous reports in the literature, the majority of patients in this series exhibited cranial neuropathies and signs of raised intracranial pressure. Nearly all of the patients had a history of acute otitis media treated with antibiotics in the weeks preceding admission. However, many patients denied high fevers or active otomastoid symptoms, which are classically associated with lateral sinus thrombosis. The diagnosis was made in all of the children by using computed tomography and MRI/venography. Treatment strategies included myringotomy tube placement, simpIe mastoidectomy, intravenous antibiotics, and anticoagulation. Posthospitalization follow-up data revealed no significant long-term complications. CONCLUSIONS. Despite appropriate antibiotic therapy, lateral sinus thrombosis and other intracranial complications of otitis media are still a threat to children in the modern era. Neurologic, rather than otologic, symptoms may dominate the presentation of otogenic lateral sinus thrombosis. Thus, a high index of suspicion may be critical for ensuring timely diagnosis of this rare condition. [ABSTRACT FROM AUTHOR]

Purpose: To report two cases of otitic hydrocephalus with long-term complications. Design Retrospective case reports. Participants: Two patients with otitic hydrocephalus with previously diagnosed otitis media. Methods: Review of clinical history, radiographic findings, medical and surgical management, and follow-up. Results: Two patients with previously diagnosed otitis media presented with otitic hydrocephalus. Both were found to have elevated opening pressures with lumbar puncture and radiographic evidence of sinus thrombosis. Although the patients received appropriate medical and surgical management, they both suffered long-term complications. Patient 1 is dependent on a ventriculoperitoneal shunt to control headaches and has required multiple shunt revisions. Patient 2 is dependent on a ventriculoperitoneal shunt to control headaches and has permanent decreased visual acuity and bilateral optic neuropathy. During her clinical course, she required an optic nerve sheath fenestration. Conclusions: Otitic hydrocephalus can result in permanent vision loss and chronic headaches requiring spinal fluid diversion. We report two cases with morbid complications. A collaborative effort from ophthalmologists, otolaryngologists, and neurosurgeons is recommended to achieve the best clinical outcome. [ABSTRACT FROM AUTHOR]

Summary: The incidence of intracranial complications of acute otitis media (AOM) has decreased and the need for operative and medical treatment is declined during the antibiotic era. To describe pathognomonic signs, evaluation management, operative findings, clinical course and outcome of otitic hydrocephalus and lateral sinus thrombosis as complications of AOM and mastoiditis in pediatric patients. Two children, 9 and 13 years old, with the diagnosis of OH and TK and MRI findings are presented. Intracranial complications in children resulted from unsuccessful treatment of AOM, which led to acute mastoiditis and lateral sinus thrombosis. Both of the presented children had thrombus in their sigmoid sinus preoperatively, demonstarated by MRI, causing decreased blood flow. Both patients underwent a mastoidectomy and delamination of sigmoid sinus with puncture of sinuses. After medical and surgical treatment, blood flow through the sinus increased significantly. In both cases signs of increased intracranial pressure ceased. The clinical presentation of otogenic lateral sinus thrombosis (LST) as a complication of acute otitis media (AOM) can be masked by antibiotic treatment. The episodes of vomiting, headache, visual impairment and a history of AOM seem to be indicative for otitic hydrocephalus. MRI scans of patients with similar symptoms should be carefully studied to facilitate the early diagnosis of dural sinus thrombosis with increased intracranial pressure. Contrast-enhanced computed tomography scan and magnetic resonance imaging play a major role in determining diagnosis and treatment plans in this intracranial complications. Management included systemic antibiotics, short-term heparin anticoagulation and surgical decompression. In our patients intensive i.v. antibiotic treatment, steroids, anticoagulants and surgery led to a significant improvement in the clinical condition. [Copyright &y& Elsevier]

Summary: Objective: : The pathogenesis of otitic hydrocephalus remains unclear. The use of radiological examination is very important to clarify both the diagnosis and the pathogenesis. In this article the role of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) is discussed. Patients: : Two patients with the diagnosis of otitic hydrocephalus and their MRI and MRV findings are presented. Results: : Both of the patients presented had thrombus in their transverse sinuses pre-operatively demonstrated by MRI causing decreased flow on MRV. After the treatment blood flow through the sinus increased significantly as the symptoms subsided. Conclusion: : MRI and MRV are valuable tools for diagnosis and follow-up of otitic hydrocephalus. [Copyright &y& Elsevier]

Objective: Evaluating intracranial complications of otitis media. Design: An Evaluative study of 106 cases of intracranial complications secondary to otitis media. Intervention: Diagnosis is based on history, clinical exam (general, systemic and ENT), investigations hemogram, X-ray mastoid CT scan brain and mastoid. Treatment: 1. Medical management: a. IV Higher Antibiotics. 2. Surgery for complicating pathology: a. Pus (in Abscesses) - brain canula aspiration, b. Lateral sinus thrombosis (thrombus removal), c. Otitic hydrocephalus (epidural catheterization). 3. Primary disease eradication: a. Exploration of mastoid. Results: Fully recovered patients without residual neurodeficit (85%), Morbidity (6%) CSF otorrhoea secondary to otitic hydrocephalus (9%) Mortality: preoperative (3%) and postoperative (6%). Conclusion: Otological approaches for management of cases of intracranial complications of otitis media are equally comparable with results by neurosurgical approaches of management. Therefore, holding promise if applied in the rural and peripheral parts of India with limited resources even with absence of the expertise of Neurosurgical Department. [ABSTRACT FROM AUTHOR]

A case of 'otitic hydrocephalus', or intracranial hypertension secondary to inflammatory thrombosis of the left lateral sinus is described. Persistently elevated intracranial pressure, which did not respond to medical treatment, led to visual deterioration. A venous bypass graft was inserted between the left lateral sinus and jugular vein and was followed by rapid resolution of the raised intracranial pressure. The indications for this procedure are discussed. [ABSTRACT FROM AUTHOR]

Otitic hydrocephalus is a rare intracranial complication of middle ear infection. It presents with features of raised intracranial pressure without any neurological deficits. Its exact pathogenesis is still not known but most associate it with lateral sinus thrombosis. Magnetic resonance imaging and Magnetic resonance venography are useful in diagnosis. We present a case of otitic hydrocephalus and discuss its clinical findings, pathogenesis, diagnostic tools, and treatment modalities. [ABSTRACT FROM AUTHOR]

Otitic hydrocephalus (OH) comprises a form of benign intracranial hypertension, which is secondary to otogenic lateral sinus thrombosis (LST). Only a small percentage of the patients with otogenic LST go into developing OH, and this may be associated with the multiplicity of anatomic variations of the cerebral venous drainage pathways. We present two pediatric cases of OH, along with a comprehensive review of the relevant literature. Both cases discussed in this article had concomitantly a rather rare anatomical variation; a high-riding, dehiscent jugular bulb, which might have played a role in the development of their clinical syndrome. The pediatric population with this particular imaging finding should receive special attention. Clinical implications of this concurrence are fitly discussed., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The purpose of this study was to review our experience with a single case of mastoiditis associated with sigmoid sinus thrombosis and increased intracranial pressure, and to review the experience of others through prior publications. We reviewed a case of a 6-year-old boy with an acute otitis media and mastoiditis, with associated ipsilateral sigmoid sinus and contralateral distal transverse sinus thrombosis. Based on the literature and our own experience, we conclude that most children with dural sinus thrombosis from acute otitis media and mastoiditis, in the setting of increased intracranial pressure, attain a good neurological outcome with a conservative neurosurgical approach. The mainstay of treatment seems to be appropriate antibiotic coverage and anticoagulation. Surgeries such as external ventricular drain, serial lumbar punctures, intracranial pressure monitor, and endovascular thrombectomy are reserved for patients with neurological deterioration despite maximal medical treatment., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: Acute otitis media (AOM) is usually self-limiting condition mainly affecting children. It may be complicated by rare but serious intra and extra cranial complications. Otitic hydrocephalus (OH) was described in 1936 by Sir Charles P. Symonds. The accepted pathophysiology is lateral cerebral sinus obliteration secondary to thrombosis and subsequent intracranial hypertension occurring after AOM. There are no clinical or serological features of meningeal irritation and no radiological features of hydrocephalus. The use of antibiotics has reduced the incidence of these complications. We report a case of permanent, bilateral visual loss secondary to AOM in an 11-year-old boy . [Copyright &y& Elsevier]