warfarin and Brain-Abscess

Management of otogenic cerebral venous thrombosis (OCVT) is controversial. Despite the modern antibiotic era OCVT still represents a potential life-threatening condition. This study aims to report the clinical presentation and management in a series of children with OCTV. The coexisting intracranial complications (ICC), the extent of the surgical treatment and the role of hypocoagulation were the analysed outcomes.. Retrospective chart review of patients aged less than 16 years and consecutively treated for OCVT at a tertiary university hospital between January 2007 and March 2015.. Sixteen children with ages ranging between 25 months and 16 years (9 girls/7 boys) with OCVT were identified. Acute otitis media was the causative factor in the majority of cases (n = 13). The remaining cases resulted from chronic otitis media with cholesteatoma (COMC). Eleven patients were under antibiotic therapy prior to admission. Other ICC were simultaneously present: intracranial abscess (n = 6); otitic hydrocephalus (n = 3); and meningitis (n = 1). Thrombus extension correlated with the presence of additional ICC (p = 0.035). Treatment in all cases comprised of broad-spectrum antibiotics, mastoidectomy, and long-range hypocoagulation with warfarin. Transtympanic ventilation tubes were inserted in all cases but one with COMC. Perioperative sigmoid sinus exposure was performed in seven patients, with drainage of perisinus empyema in three cases. Five children underwent simultaneous craniotomy for intracranial abscess drainage. Follow-up imaging performed in 12 cases revealed partial or complete recanalization in three and seven cases, respectively. After a mean hypocoagulation duration of nine months, no hemorrhagic or major neurologic complications were observed.. The clinical course of OCVT can be masked by previous antibiotic therapy. As such, a high suspicion index is needed for diagnosis. Simultaneous ICC appears to be more frequently found if an extensive thrombosis was present. The high recanalization rate in this series with low morbidity and no mortality can be obtained with a timely combination of antibiotics, mastoidectomy with transtympanic tube insertion and hypocoagulation. However, the decision to start hypocoagulation and its duration should be undertaken on an individual basis owing the possible adverse effects. Prospective and case-control studies are still needed to better clarify the role of the hypocoagulation treatment in OCVT.

Topics: Adolescent; Anti-Bacterial Agents; Anticoagulants; Brain Abscess; Child; Child, Preschool; Cholesteatoma, Middle Ear; Drainage; Female; Humans; Hydrocephalus; Infant; Intracranial Thrombosis; Male; Mastoidectomy; Meningitis; Otitis Media; Retrospective Studies; Venous Thrombosis; Warfarin

A 74-year old gentleman with a cranio-cervical abscess failed to improve after incision and drainage and standard intravenous antibiotic therapy. Imaging demonstrated thrombosis of the internal jugular vein, sigmoid sinus and transverse sinus; and microbiological analysis isolated Fusobacterium nucleatum. The diagnosis of Lemierre's syndrome was confirmed, and he was effectively treated with appropriate antibiotics and anti-coagulation.

Topics: Aged; Anti-Bacterial Agents; Anticoagulants; Brain Abscess; Drug Therapy, Combination; Humans; Jugular Veins; Lemierre Syndrome; Magnetic Resonance Imaging; Male; Sinus Thrombosis, Intracranial; Warfarin

Topics: Aged; Blood Pressure Determination; Brain Abscess; Brain Neoplasms; Cerebral Hemorrhage; Dicumarol; Female; Follow-Up Studies; Hematoma, Subdural; Humans; Intracranial Embolism and Thrombosis; Male; Prothrombin Time; Warfarin