SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Septic Cerebral Venous Thrombosis Caused by Otomastoiditis

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This poster describes a rare case of septic cerebral venous thrombosis (CVT) caused by otomastoiditis. CVT is an uncommon but serious form of stroke that can occur in young adults, women of childbearing age, and children, but should also be considered in older patients with atypical headaches, visual symptoms, seizures, altered mental status, or signs of intracranial hypertension. Risk factors include infection, thrombophilia, pregnancy, oral contraceptive use, malignancy, trauma, and venous thromboembolism.<br /><br />The case involved a 63-year-old woman who was initially hospitalized for sore throat and dysphagia and found to have right parapharyngeal cellulitis, which was treated with levofloxacin. One month later, she returned with a bilateral throbbing frontotemporal headache, blurred vision in the left eye, and right ear pain. On exam, she had tenderness over the mastoids and frontal/maxillary sinuses, but no focal neurologic deficits. Laboratory studies showed markedly elevated inflammatory markers.<br /><br />Initial CT imaging of the brain was unremarkable, but further imaging with MRI/MRV demonstrated thrombosis of the right transverse and sigmoid dural venous sinuses, along with right middle ear and mastoid effusions and skull base cellulitis/osteomyelitis, consistent with otomastoiditis-related septic CVT. Antibiotic therapy was escalated to cover resistant organisms and Pseudomonas, including vancomycin, cefepime, ceftaroline, and metronidazole.<br /><br />The poster emphasizes that normal head CT does not exclude CVT and that MRI/MRV is the preferred diagnostic test. Standard acute treatment includes anticoagulation, with endovascular or surgical options reserved for deterioration. Early recognition and prompt treatment are critical to prevent permanent neurologic injury and poor outcomes.

Asset Subtitle

Zoheb I. Sulaiman

Meta Tag

Author List Catherine Lockhart, Mark P. Visitacion, Zoheb I. Sulaiman

Category Clinical Vignettes

Concept Cerebral Venous Thrombosis

Concept Anticoagulation

Concept Magnetic Resonance Imaging

Concept Magnetic Resonance Venography

Concept Headache

Distinguished Non-Finalist

Presenter Organization AU/UGA Medical Partnership at St. Mary's Hospital

Presenting Author Zoheb I. Sulaiman

Track Adult

Keywords

septic cerebral venous thrombosis

otomastoiditis

MRI/MRV

dural venous sinus thrombosis

headache

intracranial hypertension

mastoiditis

antibiotic therapy

stroke

parapharyngeal cellulitis

Cerebral Venous Thrombosis

Anticoagulation

Magnetic Resonance Imaging

Magnetic Resonance Venography

Headache