ON TWO CASES OF OTOGENOUS THROMBOSIS OF THE SUPERIOR LONGITUDINAL SINUS

We experienced the following two cases of otogenous thrombosis of the superior longitudinal sinus.Case 1. Age, 8, female.Preceding otitis: O.m.p.chr. cholesteatom. sin.Characteristic symptoms: Increased intracranial pressure.Kernig's reaction (+). Edematous painful swelling of the scalp.Autopsy findings: Thrombosis of the left lateral, the superior longitudinal sinus and the left jugular vein. Hemorrhage in the cerebral cortex. Fibrino-purulent meningitis.Cause of death: Septico-pyemia and metastasis in the pulmonary circulation.Case 2. Age 9, male.Preceding otitis: O.m.p.chr. cholesteatom. sin.Characteristic symptoms: Increased intracranial pressure.Babinski's reflex (+). Kernig's reaction (+). Edematous painful swelling.Autopsy findings: Thrombosis of the bilateral transverse sinus. the superior longitudinal, the superior petrosal sinus and the jugular vein. Cerebral edema.Cause of death: Metastasis in the pulmonary circulation.Examining available literature, further 43 cases of this disease were considered together with the author's two cases. Victims are mostly, 13 cases among 45, small children under 10. The preceding otitis is mostly on the right side and oftener of the acute nature.In both of the present cases, the sculp developed the edematous, painful swelling, i. e. Gradanigo's symptom. This can be regarded as the sole symptom peculiar to this disease, though it may not always occur, being on record in 8 cases among 45.Intra-cranial syndrom, observed in many cases indeed, is not, however, characteristic exclusively of this disease, being common to the intra-cranial circulatory disturbance cerebral edema, hemorrhage or abscess, and secondary softening, etc.