Septic Sigmoid Sinus Thrombosis Associated with Otitis Media

Background: Septic sinus thrombosis is an uncommon clinical syndrome that can cause high morbidity and mortality. We report a case with septic thrombosis of the sigmoid sinus caused by otitis media. Case Report: A 58-year-old male presented with a 12-day history of headache. Cerebrospinal fluid (CSF) analysis showed elevated white cells (1020/uL, polymorphonuclear cells-89%), decreased CSF glucose (103 mg/dL vs. 303 mg/dL in serum), and an increased protein level (115 mg/dL). Even after empirical antibiotic treatment, the headache and fever persisted, and left abducens palsy and mild exophthalmos developed. At that time, brain MRI showed thrombosis on the right sigmoid sinus and the bilateral cavernous sinus. Additional treatment with heparin and broad-spectrum antibiotics from day 7 ameliorated his symptoms and lowered his CSF cell counts. Conclusion: In septic thrombosis of the dural sinus, early recognition and prompt management using broad-spectrum intravenous antibiotics are crucial for patient recovery. J Neurocrit Care 2013;6:101-103