A Rare Complication of Chronic Otitis Media: Septic Thrombosis of the Transverse Sinus and Meningoencephalitis due to a Parameningeal Infection. A Case Report


  • Erika Angarita Ramirez Fifth-year medical student, Universidad Del Tolima, Mental Health Observation Center Research Group (COSMOS) of the Federico Lleras Acosta Hospital, Ibagué, Tolima, Colombia. President of the Scientific Association of Medical Students of Tolima (ACEMTOL), Treasurer of the 2023-2024 Administration of the Colombian Association of Medical Students' Scientific Societies (ASCEMCOL), Facilitator in voluntary interruption of pregnancy Medical Student for Choice, Facilitator in psychological first aid ASCEMCOL, Student Representative to the Curricular Committee Medicine Program University of Tolima.
  • Enrique Steff Hernandez MD, Clinical Neurologist, Universidad Nacional de Colombia. Master in HIV, Rey Juan Carlos University, Madrid-Spain. Training in Neuroinfectology, Instituto de Infectologia Emílio Ribas, São Paulo – Brazil. Neurologist at Hospital Federico Lleras Acosta - Clínica Medicadiz - Clínica Sharon, Ibagué. Professor at the University of Tolima. Coordinator of the Academic Group in Neuroinfections and Systemic Diseases of the Colombian Association of Neurology.
  • Laura Sofia Cordoba MD, Universidad Cooperativa de Colombia.




Septic thrombosis, Dural Venous Sinuses, Meningoencephalitis, Otitis Media, Mastoiditis


BACKGROUND: Septic cerebral venous sinus thrombosis or septic cavernous thrombosis is an extremely rare disorder, with 2 to 13 cases per million per year, following the introduction of antibiotics and advances in diagnostic imaging. It is a complex pathology, difficult to diagnose and life threatening. It has a high risk of otoneurologic sequelae, and it requires follow-up by various specialties, as treatment is medical and surgical, including neurology, internal medicine, intensive care, otorhinolaryngology, and infectiology, among others. Due to the low occurrence of septic cavernous thrombosis, the diagnosis may be erroneous or delayed, increasing complications and mortality. It is essential to perform a complete physical examination with emphasis on the ophthalmological, otological, rhinosinusal and neurological examinations, which is why this case is described.

THE CASE: We describe a 77-year-old male patient, with history of high blood pressure, nasopharyngeal carcinoma in remission, bilateral hearing loss, prostatic hyperplasia, otitis media, and chronic mastoiditis. He was admitted due sudden onset of difficulty standing, gait instability, mutism, unquantified fever spikes, headache, and vertigo. The initial laboratory tests only revealed a complete blood count with leukocytosis. A simple brain computed tomography (CT) scan did not show relevant findings; therefore, a lumbar puncture (LP) was carried out due to suspicion of bacterial meningoencephalitis. Analysis of cerebrospinal fluid (CSF) showed pleocytosis with a predominance of polymorphonuclear cells, hypoglycorrhachia and hyperproteinorrachia. Empirical antibiotic therapy was started with Vancomycin and Cefepime. At day five since onset of symptoms, he did not have improvements of his symptoms, so a new LP was carried out and antibiotic therapy was escalated. In the CSF it was found an increased cellularity with greater hypoglycorrhachia, persistent hyperproteinorrachia, and cellular shift to lymphocyte predominance. A contrast-enhanced magnetic resonance imaging (MRI) of the brain was requested, showing pyogenic ventriculitis and decreased flow at the left transverse sinus, suggesting possible thrombosis, which was later confirmed with a contrast-enhanced brain angio-MRI. Furthermore, due to the otological involvement, a CT scan of the ears was performed, which showed severe bilateral otomastoiditis with bilateral mastoid cholesteatomas, bilateral otitis externa, and osteomyelitis of the left petrous apex. A diagnosis of a septic thrombosis of the left transverse sinus, in the context of meningoencephalitis secondary to a parameningeal focus, was made. Treatment with Meropenem 1 gr intravenously every 8 hours and Vancomycin 1 gr every 8 hours was continued up to 28 days. During the hospitalization, otorhinolaryngology did a mastoidectomy and continued outpatient antibiotic management with Ciprofloxacin for seven more days. The patient did not require anticoagulation, and at follow-up he was notably recovered, and in control studies the recanalization of the thrombosis was confirmed.

CONCLUSION: Septic cerebral venous sinus thrombosis is a rare pathology, but with a high associated morbidity and mortality, which requires multidisciplinary management. It is vital to know its pathophysiology and predisposing factors to include it in differential diagnoses when managing a patient with meningeal symptoms.


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How to Cite

Angarita Ramirez, E., Hernandez, E. S., & Cordoba, L. S. (2023). A Rare Complication of Chronic Otitis Media: Septic Thrombosis of the Transverse Sinus and Meningoencephalitis due to a Parameningeal Infection. A Case Report. International Journal of Medical Students, 11, S74. https://doi.org/10.5195/ijms.2023.2373



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