Optic Nerve Atrophy as a Complication of Acute Otitis Media – Case Report.
str. 52 – 55
Autorzy: Małgorzata Danowska1, Marta Wyszyńska1, Maria Wolniewicz2, Wojciech Hautz1.
1. Klinika Okulistyki Instytutu „Pomnik – Centrum Zdrowia Dziecka” w Warszawie.
Kierownik: dr hab. n. med. Wojciech Hautz.
2. Klinika Otolaryngologii Dziecięcej Warszawskiego Uniwersytetu Medycznego, Samodzielny Publiczny Dziecięcy Szpital Kliniczny im. Józefa Polikarpa Brudzińskiego w Warszawie.
Kierownik: dr hab. n. med. Lidia Zawadzka-Głos.
Acute otitis media is one of the commonest illnesses in paediatric population. Nowadays, due to the development of broad-spectrum antibiotic therapy and the introduction of pneumococcal polyvalent vaccines the incidence of otitis media and its sequelae has significantly decreased. However, clinicians should still maintain awareness of its possible extra- and intracranial complications, which may often pose a diagnostic challenge and require an interdisciplinary approach.
Lateral sinus thrombosis constitutes a rare but potentially mortal complication of acute otitis media. The anatomical proximity of the mastoid cells and the sigmoid sinus facilitates spread of the otogenic infection leading to bone erosion, sinus wall necrosis and subsequent thrombus formation. Arrest in the venous flow obstructs the circulation of the cerebrospinal fluid thus causing a rise in intracranial pressure.
Therefore every child with acute otitis media exhibiting symptoms of raised intracranial pressure requires an immediate diagnostic process, usually involving contrast-enhanced computed tomography as the investigation of choice. Magnetic resonance and magnetic resonance venography are also considered a diagnostic aid due to their higher sensitivity in detecting the thrombus. The management of lateral sinus thrombosis consists of broad-spectrum antibiotic therapy and a surgical removal of the source of infection. Some patients may also benefit from anticoagulants.
A persisting papilledema due to the raised intracranial pressure may eventually lead to optic nerve atrophy and decrease in vision. Therefore all patients with intracranial hypertension should be carefully examined by ophthalmologists. Steroid therapy to lower of the intracranial pressure may be crucial in order to prevent vision.
We herein report a case of otitis media associated with lateral sinus thrombosis resulting in optic nerve atrophy.
Keywords: otitis media, lateral sinus thrombosis, otitic hydrocephalus, papilledema, optic atrophy.
Słowa kluczowe: zapalenie ucha środkowego, zakrzepica zatok żylnych mózgu, usznopochodne nadciśnienie śródczaszkowe, tarcza zastoinowa, zanik nerwu wzrokowego.