IPoster: Diplopia and Bilateral Optic Nerve Edema: A Case of Lateral Sinus Thrombosis (LST) Secondary to Mastoditis in the Pediatric Patient

Introduction: Otitis media and mastoiditis are fairly common occurrences in the pediatric population and are among the most common reasons children will see ENT specialists. However, a rare but very possible complication can include sinus thrombosis, more specifically lateral sinus involvement. This can result in an increased intracranial pressure (ICP) thus result in bilateral optic nerve edema and/ or diplopia due to sixth nerve palsies.

Case Report: A 5 year-old Caucasian female was referred to our clinic for diplopia following a 3 day hospital stay for treatment of dehydration, headache, vomiting, acute otitis media and mastoiditis. Best corrected visual acuities were 20/30 OD and 20/30- OS. Pupils were normal without APD but she was noted to have a mild left sixth nerve palsy. Anterior segment was within normal limits both eyes but the dilated examination revealed grade 3+ bilateral optic nerve edema. A CT scan had been performed when the patient was in the hospital so an MRI/MRA was ordered urgently for this patient which demonstrated a resolving left lateral sinus thrombosis with a suspected etiology of acute mastoiditis. She was re-admitted and treated with additional antibiotics and given anti-coagulant treatment until resolution of the thrombosis.

Discussion: Lateral Sinus Thrombosis (LST) while rare, can be a complication of mastoiditis. It had almost 100% mortality rate before the intervention of antibiotics at the beginning. Therefore if not diagnosed, the rate of mortality or morbidity is extremely high especially in the pediatric population. Ocular findings including optic disc edema and nerve palsies often occur with this condition.

Conclusion(s): Ocular signs and symptoms may be the first findings in LST and therefore requires the pediatric eye care provider to be an essential part in making the diagnosis and assisting with proper management of these patients. Co-management with neurology, otolaryngology and hematology are often critical in these cases.