Acute mastoiditis complicated by cerebral venous sinus thrombosis, meningitis, and early intracranial abscess formation
Presentation
Uncontrolled diabetes mellitus. Severe headache, discharge from the left ear, and fever for the last 15-20 days.
Patient Data
MRI with mastoid bone
Left temporal lobe round lesion which elicits T1WI hypointense and T2WI hyperintense with a peripheral hypointense thin wall and surrounding vasogenic edema. The lesion does not show complete attenuation in FLAIR images. Moderate central diffusion restriction is noted in DW images. In post-contrast images, the lesion shows a thin rim of wall enhancement. Enhancement of adjacent dura is also noted. The lesion results in a mass effect and compresses the adjacent medial temporal lobe.
Fluid collection and soft tissue swelling are seen within the left temporal region.
The left transverse and sigmoid sinuses are enlarged. In post-contrast images, intense sinus wall enhancement with central non-enhancing component is noted. The non-enhancing component shows intense diffusion restriction in DW images.
Case Discussion
This patient presented with a history of severe headache, fever, and left ear discharge. MRI features are consistent with left-sided mastoiditis invading the left transverse and sigmoid sinuses and resulting in venous sinus thrombosis. Thickening and enhancement of the dura are seen in the left temporal region, which suggests meningitis. The infection has an intracranial extension, resulting in early abscess formation as well as surrounding vasogenic edema.
Dural venous sinus thrombosis, meningitis, and intracranial abscess are rare and serious complications of acute mastoiditis. The mortality rate is very high in untreated cases. This was a frequent condition in the pre-antibiotic era. However, the invention and use of antibiotics have limited the incidence nowadays. In the modern era, this condition is mainly found among children and immunocompromised patients.
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