BINOCULAR DIPLOPIA REVEALING THROMBOSIS OF THE LATERAL SINUS: ABOUT A CASE
Published 2022 - 26th ESCRS Winter Meeting
Reference: P217 | Type: Abstracts | DOI: 10.82333/1kcm-4y91
Authors: Anass Boujaada* 1 , Younes Tlemcani 2 , ElHassan Abdallah 3 , Amina Berraho 3
1Ophtalmologie B,CHU Ibn Sina,Rabat,Morocco, 2Ophtalmologie B,CHU ibn sina,Rabat,Morocco, 3ophtalmologie B,CHU Ibn Sina,Rabat,Morocco
Purpose
dural sinuses. Initially described by Ribes in the early 19th century.
Septic venous thrombosis of the lateral sinus of otogenic origin is a frequent and serious complication of mastoiditis, described in children. Adult mastoiditis is rare, complicated by thrombosis septic lateral sinus in 3% of cases.
We report here the observation of a patient seen at the ophthalmology consultation for diplopia, and
whose radiological work-up revealed thrombosis of the lateral sinus of otogenic origin.
Setting
Methods
This is a 15-year-old girl with a history of recurrent left otitis, consulting emergency for headaches associated with binocular diplopia and visual blurring. The ophthalmological examination objected: visual acuity was 7/10 in the right eye and 8/10 in the left eye. Ocular mobility retained in both eyes. Examination of the anterior segment is unremarkable. The fundus revealed bilateral papillary edema of stage II stasis. The patient also reported left otalgia and dizziness, so an ENT examination was requested objectifying purulent otorrhea, fetid on the left with an inflammatory external ear canal, painful inflammatory retroauricular swelling, and a fever at 39°C.
Results
A brain scan was done to look for a cerebral meningeal complication. The CT showed two retroauricular hypodense collections enhanced peripherally containing air bubbles. First collection was communicating with the mastoid, site of an abscess through bone lysis, which is in contact with the left lateral sinus, this sinus contains air bubbles with defect of enhancement in c + suggesting a thrombophlebitis. the second collection is more posterior measuring 17x7 mm
An anti-coagulation by low molecular weight heparin (LMWH) at a curative dose associated with an
antibiotherapy based on ceftriaxone 2g / day and mitronidazole 500mgx 3 / day were prescribed. The excision posterior for the infected cholesteatoma was performed.
Antibiotherapy and anti-coagulation allowed rapid regression of clinical signs.
Conclusion
Lateral sinus thrombosis is a serious complication of middle ear infection. The diagnosis is based on clinical examination and imaging (CT). Treatment is currently widely known in; combining antibiotherapy, anticoagulant treatment and surgical means; which made it possible to reduce 0-16% mortality.