Pediatric Otitic Hydrocephalus associated with Otogenic Lateral Sinus Thrombosis in Acute Mastoiditis

EnglishIntroduction: Acute mastoiditis may be associated with intracranial complications such as lateral sinus thrombosis. As a consequence, children may, exceptionally, develop otitic hydrocephalus, presented by symptoms and signs of elevated intracranial pressure. A high clinical suspicion is essential for an early diagnosis, in order to achieve the best clinical outcome. Case Report: A seven-year-old female patient, previously diagnosed with acute otitis media in the right ear, presented with a progressively increasing frontal headache, photophobia and diplopia. A head computed tomography revealed a right ear mastoiditis with lateral sinus thrombosis. Magnetic resonance angiography confirmed an ipsilateral transverse sinus, sigmoid sinus and internal jugular vein thrombosis. Neuro-ophthalmologic examination confirmed bilateral abducens nerve palsy and severe bilateral papilledema, following intracranial hypertension. The patient underwent prompt surgical treatment with myringotomy with transtympanic tube placement and mastoidectomy with perisinus empyema drainage, having started intravenous antibiotic therapy and anticoagulation. After diuretic therapy, systemic steroids and two lumbar punctures the patient had a complete recovery. Discussion: Otitic hydrocephalus is a rare but potentially fatal complication of otitis media. It is associated with cerebral venous thrombosis, therefore a multidisciplinary assessment, involving specialties such as neurology and ophthalmology is essential to evaluate ocular and neurologic symptoms. In the presence of intracranial hypertension, early treatment is critical to improve headache and prevent permanent vision loss. portuguesIntroducao: A mastoidite aguda pode estar associada a complicacoes intracranianas como e o caso da trombose do seio lateral. Na sequencia desta, excecionalmente, pode desenvolver-se um quadro de hidrocefalia otitica, manifestando-se por sinais e sintomas de hipertensao intracraniana. Um elevado grau de suspeicao clinica e essencial para um diagnostico precoce, de forma a melhorar o prognostico destes doentes. Caso Clinico: Crianca do sexo feminino, de 7 anos de idade, previamente diagnosticada com otite media aguda a direita e que inicia quadro de cefaleias frontais intensas, fotofobia e diplopia. A tomografia computorizada (TC) cerebral revelou otomastoidite com suspeita de trombose do seio lateral. Realizou Angio-Ressonância Magnetica (Angio-RM) cerebral que confirmou a presenca de trombose da porcao distal do seio transverso, seio sigmoide e veia jugular interna. A observacao por Oftalmologia e Neurologia Pediatrica confirmou paralisia bilateral do VI par craniano e papiledema bilateral, na sequencia de hipertensao intracraniana. Foi submetida a miringotomia com colocacao de tubo de ventilacao transtimpânico e mastoidectomia simples com drenagem de empiema perisinusal, tendo iniciado antibioterapia endovenosa e hipocoagulacao. Apos terapeutica diuretica, corticoterapia sistemica e duas puncoes lombares evacuadoras verificou-se uma boa evolucao clinica, com recuperacao completa. Discussao: A hidrocefalia otitica e uma complicacao rara mas potencialmente fatal da otite media. Na presenca de trombose venosa cerebral, e essencial uma avaliacao multidisciplinar, envolvendo especialidades como Neurologia e Oftalmologia, de forma a avaliar a presenca de sintomas oculares e/ou neurologicos. Na presenca de hipertensao intracraniana, o tratamento precoce e fundamental para melhorar a cefaleia e prevenir perda de visao permanente.