Learning objectives
TEACHING POINTS:
Review the imaging findings of the Cytotoxic Lesion of the Corpus Callosum and Dural venous sinus thrombosis
Introduce example case and follow clinical course of the patient and imaging findings on multimodality imaging including CT and MRI.
Background
BACKGROUND:
The intracerebral complications of acute mastoiditis are well documented and include cerebral venous sinus thrombosis (CVST), intracranial abscesses, cranial nerve palsies, meningitis and osteomyelitis.1 CVST is a well-documented complication of acute mastoiditis in the paediatric population, with a recently published retrospective cohort study reporting the incidence as high as 25%.1 The varying aetiologies of CVST are extensive and are classified as either genetic or acquired. Despite the broad differential in causative pathologies, there is a shared underlying pathological prothrombotic state. The basic pathophysiological principles...
Imaging findings OR Procedure details
CLINICAL COURSE
We present a pictorial case of a 12-year-old male presenting to the emergency department with a fever and unilateral otalgia, who was diagnosed with a complicated otomastoiditis with dual neuroparenchymal sequelae including both CSVT of the dural sinus and CLOCC of the splenium.
Initial assessment with a contrast enhanced CT were in keeping with an extensive otomastoiditis with complicated skull base osteomyelitis. Furthermore, initial imaging demonstrated an occlusive thrombus of the sigmoid sinus, extending to the right internal jugular vein and transverse sinus....
Conclusion
One of the well documented findings of CLOCC is infection, however there are multiple other entities which may show this finding, and it seems the pathogenesis is related to acute cytotoxic oedema mediated by inflammatory cascade. This case highlights the dual pathologies and explores the clinical course, imaging findings and post treatment response. We suspect that cytotoxic lesions of the corpus collosum is likely a sequalae of skull base osteomyelitis or dural venous sinus thrombosis in this circumstance. Acquiring further information regarding the incidence, patient...
References
References:
Vergadi E, Velegrakis S, Raissaki M, Bitsori M, Karatzanis A, Galanakis E. Acute mastoiditis complicated by cerebral venous sinus thrombosis in children.International journal of pediatric otorhinolaryngology. 2021;141:110508-110508. doi:10.1016/j.ijporl.2020.110508
Taksande A, Meshram R, Yadav P, Lohakare A. Rare presentation of cerebral venous sinus thrombosis in a child.Journal of pediatric neurosciences. 2017;12(4):389-392. doi:10.4103/JPN.JPN_109_17
Dlamini N, Billinghurst L, Kirkham FJ. Cerebral Venous Sinus (Sinovenous) Thrombosis in Children.Neurosurgery clinics of North America. 2010;21(3):511-527. doi:10.1016/j.nec.2010.03.006
Sébire G, Tabarki B, Saunders DE, et al. Cerebral venous sinus thrombosis in children:...