Lateral Sinus Thrombophlebitis

LATERAL SINUS THROMBOPHLEBITIS (SIGMOID SINUS THROMBOSIS)
Lateral or sigmoid sinus thrombophlebitis arises from inflammation in the adjacent mastoid.
It may occur as a complication of :
  1. Acute coalescent mastoiditis
  2. CSOM and cholesteatoma Clinical features
Hectic Picket-Fence type of fever with rigor.
  • Patients presents with low grade intermittent fever, that can progress to a spiking, picket fence pattern secondary to the dissemination of septic emboli into the systemic circulation. 
  • They can also develop torticollis and neck tenderness particularly along the course of internal jugular vein. 
  • Headache, Progressive anemia and emaciation.
  • Griesinger's sign : - odema over the posterior part of mastoid due to thrombosis of mastoid emissary veins.
  • Papilloedema
  • Tobey-Ayer test :- Compression of vein on the thrombosed side produces no effect while compression of vein on healthy side produces rapid rise in CSF pressure which will be equal to bilateral compression of jugular veins.
  • Crowe-Beck test :- Pressure on jugular vein of healthy side produces engorgement of retinal veins. Pressure on affected side does not produce such change.
  • Tenderness along jugular vein
  • Imaging studies
  • Contrast-enhanced CT scan can show sinus thrombosis by typical delta-sign. It is a triangular area with rim enhancement, and central low density area is seen in posterior cranial fossa on axial cuts.
  • Delta-sign may also be seen on contrast enhanced MRI.
  • MR venogram is helpful in showing the degree of thrombus extension within the venous system. 
Management:
  • Operation of choice in a patient with Attic cholesteatoma of ear with lateral sinus thromboplebitis would be Canal Wall Down Mastoidectomy.
Exam Question
  • Presence of delta sign on contrast enhanced CT SCAN suggests presence of Lateral Sinus thrombophlebitis.
  • Operation of choice in a patient with Attic cholesteatoma of ear with lateral sinus thromboplebitis would be Canal Wall Down Mastoidectomy.
  • Griesinger's sign is seen in Lateral Sinus Thrombosis.
  • Lateral sinus thrombosis is associated Greisinger sign, Lily-Crowe sign and positive Tobey Ayer test.

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