Endocrine Abstracts

Background: Otogenic cerebral thrombophlebitis is a rare intracranial complication of otitis media in the modern age of antibiotic treatment, but it is potentially a dangerous complication spatially in immune depressed patients with diabetes.

Aim: To discuss the clinical features of this complication and to analyze the impact of diabetes on its evolution as well as the management of this entity.

Methods: We conducted a retrospective study on 10 diabetic patients with otogenic cerebral thrombophlebitis diagnosed and treated in ENT Departement of Farhat Hached Hospital from 1995 to 2019.

Results: 10 poorly controlled diabetic patients were enrolled :8 men and 2 women with a mean age of 35 ans (extremes from 11 to 77 ans). The mean delay of consultation was 27 days (extremes from 7 days 3 months). Clinical presentation was made of otlagia in all patients and otorreha in 9 patients. The etiology was acute otitis media in 8 cases and cholesteatoma otitis media in 2 cases. All patients were assessed by CT Scan with contrast .The thrombosis was located in lateral sinus in 5 cases, sigmoide sinus in 2 case, Cavernous sinus in 1 case, and internal jugular vein in 30% of cases. The thrombphlebitis was on the right side in 3 cases, on the left side in 6 cases and bilateral in 1 case. The occlusion was total in 4 cases and partial in 6 cases. It was associated to other complications : mastoiditis in 5 cases, extradural empyema in 2 cases and cerebral abcess in 3 cases. The treatment was based on insulinotherapy, antibiotherapy and anticoagulation for 15 days to 3 months in alla cases. Surgical management was completed in 5 cases.

Conclusion: Otogenic cerebral thrombophlebitis in a rare and seriuos complicaion, more common in diabetic patients who are immunodepressed. Its diagnosis is based on CT Scan. It requires well controlling diabetes, antiobiotheray, anticoagulation with surgical drainge.