Bilateral abducens nerve paresis as initial symptom of a Sinus vein thrombosis
M. Lang¹, J. Schmidbauer¹, M. Voges², B. Käsmann-Kellner¹, B. Heinemann-Vernaleken¹
Introduction: Sinus vein thrombosis is a rare intracerebral complication of mastoiditis. We report on clinical ophthalmological symptomatology of this secondary illness.
Patient and methods: History: A fourteen-year-old girl presented complaining of horizontal diplopia since one week. External neurological consultation had shown no pathological results, especially no signs of meningitis. Two weeks ago the patient suffered off otitis media and was treated with antibiotics which improved the findings. Clinical course: Best corrected visual acuity was 20/20 OD/OS. Ocular alignment revealed an esotropia of C 6° with homonymous diplopia and bilateral abductional deficit. Ophthalmoscopically bilateral papilledema was evident. MRT and MR-angiography showed mastoiditis and thrombosis of Sinus sigmoideus and transversus. Therapy: Following mastoidectomy, high-dose antibiotic therapy and full-dose heparin-therapy a fast improvement occurred.
Conclusion: Thrombosis of the Sinus sigmoideus following mastoiditis is a rare but severe complication of middle ear inflammation. Immediate surgical and angibiotic therapy is necessary. Possibly symptomatology occurs even when the primary focus seems to resolve.
¹Eye hospital, ²Department of neuroradiology, University of Saarland, Kirrbergerstr. 1, D - 66424 Homburg/Saar