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Título

Septic thrombosis of the transverse and sigmoid sinus, discussion about the introduction of full anticoagulation: Case Report

RESUMO

Case Presentation: Septic sigmoid sinus thrombosis is a rare disease and is commonly caused by middle ear infections, with Staphylococcus aureus being the main etiologic agent. Clinical manifestations are diverse and headache is the most frequent complaint followed by focal deficits such as cranial nerve involvement. Radiological investigation and lumbar puncture are important in aiding the diagnosis. To discuss the controversial use of full anticoagulation in cases of septic thrombosis, describing a patient treated at a tertiary hospital in which it was decided not to introduce this therapy. Discuss: G.S.P.L, 15 years old, male, admitted with a report of otalgia due to refractory oral antibiotic therapy. Evolved with vomiting, loss of appetite, persistent fever and periods of sleepiness. A neurological examination showed rigth appendicular ataxia and purulent discharge from the external auditory canal directly to otoscopy. Performed cranial tomography with diffuse veiling of the cells of the mastoid and the right middle ear and hypodensity of the right cerebellar hemisphere with a nonspecific appearance. Cerebrospinal fluid was collected with pleocytosis and hyperproteinorraquia. During hospitalization, a Cranial Magnetic Resonance with Angioresonance was performed, which showed opacification of the mastoid cells and tympanic cleft on the right and filling failure in the sigmoid and adjacent transverse sinus, inferring venous thrombosis. Broad-spectrum antibiotic therapy was started for a long time and a surgical approach was scheduled with the otorhinolaryngology team. Final Comments: When questioned about the use of anticoagulants, the benefit was not superior to the risks related to this therapy, the use prevents the persistence of the thrombus, but it can facilitate the release of septic emboli and increase the risk of bleeding. Thus, in the case reported, a conservative approach was chosen, based on antibiotic therapy and neurological surveillance without the introduction of anticoagulation.

Palavras Chave

Septic sigmoid sinus thrombosis;septic thrombosis;middle ear infections;mastoiditis;anticoagulation;