OTO MASTOIDITIS AND SEPTIC CEREBRAL VENOUS THROMBOSIS

Abstract

11 yr old female child, admitted with history of fever, left ear pain, swelling behind the left ear of 5 days duration, for which she was treated by a nearby doctor. After 1 week the child had left ear discharge, headache, neck pain, recurrent episodes of vomiting. On general examination she is thin built, febrile, toxic and dehydrated. On local examination she had ear discharge, swelling behind the left ear. On neurological examination, she had neck stifness. Routine blood investigations including, CBC, LFT, RFT were normal. On CSF examination Protein-188 mg%,Sugar- 16 mg%,Cell count-165 cells/cumm,85% were Neutrophils. Aural swab C/S showed growth of Klebsiella sensitive to Amikacin, Ciprooxacin, Piperacillin / Tazobactum and Cotrimoxazole. ENT opinion was in favour of doing Mastoidectomy. HRCT Temporal bone showed complete opacication of external auditory canal, tympanic cavity and mastoid air cells with a possibility of lling up with pus. MRI BRAIN showed Left mastoid and postauricular abscess, mastoiditis, ventriculitis, venulitis with thrombosis of left transverse and sigmoid sinuses. Patient was treated with parenteral piperacillin tazobactum, Ciprooxacin, Amikacin, Metronidazole, Mannitol, Dexamethasone and Low molecular weight heparin.Patient improved in 3 weeks.Ear discharge dried up, mastoid abscess subsided, and the child became active and ambulant