Hooper first described
infective thrombosis of the lateral sinus in 1826. This disease
was universally fatal until Lane established surgical intervention
The thrombus can be
identified by its signal intensity on MRI and the flow void in the
affected sinus is clearly documented on MR angiography.
Classic symptoms of
LST include a "picket fence" fever pattern; chills; progressive
anemia (especially with beta-hemolytic strep); and, symptoms of
septic emboli, headache and papilledema may indicate extension to
involve the cavernous sinus.
intact boney walls and protective granulations provide natural defense
barriers within the middle ear; complications occur when these are
overcome. The spread of infection through the natural defenses can
occur by osteothrombosis, bone erosion and when present along preformed
Before the advent of
antibiotic therapy, the mortality of all intracranial complications
was extraordinarily high. In spite of advances in surgical techniques
mortality remained at nearly 50% until the introduction of antibiotics.
In a study of autopsy
statistics at LA County Hospital, it was found that before the introduction
of antibiotics approximately 25:1,000 deaths were due to an intracranial
complication of otitis media. The death rate from these complications
dropped 90% after the introduction of antibiotics.
The intracranial complications
of otitis media include purulent meningitis, extradural or peridural
abscess, LST, brain abscess and otitic hydrocephalus.
Treatment is always
surgical removal of the infected thrombosis in addition to broad
spectrum antibiotic coverage.
Lateral sinus thrombosis
(LST) and other intracranial complications of otitis media still
occur in the practice of otology. The disease is often modified
by prior antibiotic treatment, making the diagnosis and management