Cerebral venous sinus thrombosis as a complication of mastoiditis case report with literature review

Abstract: Introduction: Mastoiditis is the inflammation of the mastoid part of the temporal bone, specifically the mastoid air cells. It most commonly occurs as a complication of middle ear infection. Mastoiditis is a clinical diagnosis, and antibiotics play a central role in its treatment. Cerebral venous sinus thrombosis is a rare intracranial complication of acute mastoiditis. Case Presentation: A 49-year-old patient presented with tinnitus in the left ear, vertigo accompanied by nausea and vomiting, and stiffness of the neck. A general clinical and neurological examination was performed, which was normal at that time. Otoscopic examination of both ears was also normal. The patient was afebrile. Symptomatic treatment was prescribed, including analgesics, muscle relaxants, Betahistine, and a B complex vitamin. Two days later, the patient returned with worsened symptoms, including a feeling of fullness and pain in the left ear, occasional discharge from the same ear, and severe pain and stiffness in the left side of the neck. Due to significant pain, the clinical examination was limited. Inspection revealed retroauricular swelling in the area of the left mastoid and the left side of the neck. The patient was urgently referred for consultation with an otorhinolaryngologist and neurologist at a regional hospital, who indicated an urgent non-contrast CT of the endocranium and laboratory tests. CT of the endocranium confirmed the presence of venous sinus thrombosis along with inflammation of the left mastoid air cells. Radical trepanation of the temporal bone/mastoidectomy on the left side was performed. During hospitalization, parenteral antibiotic, anticoagulant, and supportive therapy were administered. The patient reported subjective improvement with the treatment, and follow-up clinical, laboratory, and CT findings indicated regression of the inflammatory process. Conclusion: In patients with ear pain, the most common symptom of middle or outer ear infection, it is important during the examination to identify typical signs of retroauricular inflammation (swelling, redness, and tenderness) as an indication of mastoiditis. Mastoiditis is the second most common complication of acute otitis media. Timely diagnosis and appropriate treatment of mastoiditis reduce the risk of complications, such as cerebral venous sinus thrombosis.