Ayşenur KISAARSLAN PAÇ, Yasemin TORUN ALTUNER, Hümeyra ASLANER, Mehmet SOMTAŞ, Ümmügülsüm GÜMÜŞ

Başağrısı ve kusma ile başvuran lateral sinus trombozu olgusu

Lateral sinus trombozu otitis medianın nadir intrakranial komplikasyonlarından biridir. Kusma ve baş ağrısı ile başvuran 12 yaşında kız hastanın yaklaşık on gündür devam eden şikayetlerinin yedi kilogram kayba neden olduğu, altı gün seftriakson enjeksiyonu yapıldığı, sık üst solunum yolu enfeksiyonu ve orta kulak iltihabı geçirdiği öğrenildi. Fizik muayenesinde; sağ dış kulak yolu muayenede ağrılı, sağ kulak zarı mat idi. Laboratuar incelemesinde hemogram, periferik yayma, kan biyokimyası, brusella tüp aglütinasyon testi, batın ultrasonu ve akciğer grafisi normal olarak tespit edildi. CRP 65 mg/L, sedimantasyon 26 mm/sa, PT:15,1 sn, PTT: 29,8 sn, fibrinojen 280 mg/dl, idrar tahlilinde 3+ keton mevcut idi. Homosistein seviyesi normal, MTFHR A1298C heterozigot tespit edildi.Yapılan MR incelemede sağda kronik otitis media ile uyumlu değişiklikler, sağ lateral ve sigmoid sinüste tromboz tespit edildi. Hastaya sağ timpanomasteidektomi yapıldı, ventilasyon tüpü takıldı ve postoperatif enoxaparin başlandı. Dirençli kusma ve başağrısı olan hastada intrakranial nedenlerin hızlı bir şekilde değerlendirilmesi gerekmektedir. Biz bu vakada kronik otitis medianın nadir bir komplikasyonu olan lateral sinus trombozunun intrakranial nedenler arasında düşünülmesi gerektiğini vurgulamayı amaçladık.

Lateral sinus thrombosis patient presenting with headache and vomiting

Lateral sinus thrombosis is rare intracranial complications of otitis media. A 12 years old girl patient presented with complaints of vomiting and headeche. Patient treated with ceftriaxone had lost seven kilograms in ten days. There were complaints of frequent upper way infection and otitis media. Physical examination of right ear was painful and right tympanic membrane was pale. Laboratory tests shuch as hemogram, blood smear, Brucella tube agglütination test, biochemistry tests, abdomen ultrasaund and chest X-ray were all normal. Besides a CRP was 65 mg/L and sedimantation rate was 26 mm/h. PT and PTT values were 15,1 and 29,8s respectively, fibrinogen was 280 mg/dl. In urine analysis +3 keton bodies were observed. Homosistein level was normal, MTFHR gene polymorphism was heterozigot A1298C. Magnetic resonance imaging (MRI) showed right chronic otitis media and thrombosis in both lateral and sigmoid sinuses. She was treated mastoidectomy and concurrent middle ear ventilation tubes. Enoxaparin was also started in postoperative treatment. Intracranial problems must be rapidly evaluated in patients with headache and vomiting. In this study we aimed to emphasize that lateral sinus thrombosis has to be taken into consideration in patients complainig intracranial problems with headache and vomiting.

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