Rosero-Castillo Astrid, Almendariz-Ramos Diana, Treviño-González Jose
Otolaryngology - Head and Neck Surgery, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma De Nuevo Leon, Monterrey, MEX.
Cureus. 2025 May 13;17(5):e84045. doi: 10.7759/cureus.84045. eCollection 2025 May.
Acute otitis media (AOM) is common in children, but intracranial complications such as meningitis, cerebral abscess, and cerebral venous sinus thrombosis are rare and can be potentially life-threatening. This case describes a three-year-old boy who presented to the emergency room following one week of coryza, fever, cough, malaise, and otalgia, along with three days of severe headache and vomiting. Physical examination revealed hyperemia and bulging of both tympanic membranes on otoscopy, along with an elevated erythrocyte sedimentation rate and elevated levels of leukocytes, C-reactive protein, and D-dimer. Cranial computed tomography scan revealed soft tissue density occupying the mastoid cells bilaterally and enlargement of the right transverse and sigmoid venous sinuses; magnetic resonance imaging of the brain revealed thrombophlebitis in the right internal jugular vein and thrombosis in the transverse and sigmoid sinuses. The diagnosis was bilateral AOM with otogenic lateral right sinus thrombosis, and the patient had also developed bilateral sixth cranial nerve paresis and cerebellitis. He made a full recovery without any sequelae, following treatment that included the placement of tympanostomy tubes in both ears, a 21-day course of systemic antibiotics, and two weeks of anticoagulation therapy with low molecular-weight heparin. Follow-up showed clinical improvement and normalization of inflammatory markers; the radiological images showed complete resolution of thrombosis. Since otogenic lateral sinus thrombosis symptoms can mimic uncomplicated AOM, maintaining a high index of suspicion is essential in preventing fatal outcomes and ensuring favorable recovery in pediatric patients.
急性中耳炎（AOM）在儿童中很常见，但颅内并发症如脑膜炎、脑脓肿和脑静脉窦血栓形成很少见，且可能危及生命。本病例描述了一名三岁男孩，他在出现一周的鼻炎、发热、咳嗽、不适和耳痛后，又出现了三天的严重头痛和呕吐，随后被送往急诊室。体格检查显示，耳镜检查时双侧鼓膜充血、膨出，同时红细胞沉降率升高，白细胞、C反应蛋白和D-二聚体水平升高。头颅计算机断层扫描显示双侧乳突气房有软组织密度影，右侧横窦和乙状窦增宽；脑部磁共振成像显示右侧颈内静脉血栓性静脉炎以及横窦和乙状窦血栓形成。诊断为双侧急性中耳炎伴右侧耳源性外侧窦血栓形成，该患者还出现了双侧第六颅神经麻痹和小脑炎。在接受包括双耳鼓膜置管、21天的全身抗生素治疗以及两周的低分子肝素抗凝治疗后，他完全康复，没有任何后遗症。随访显示临床症状改善，炎症指标恢复正常；影像学检查显示血栓完全溶解。由于耳源性外侧窦血栓形成的症状可能与单纯性急性中耳炎相似，因此保持高度怀疑对于预防儿科患者的致命后果和确保良好康复至关重要。
