Acute mastoiditis–associated cerebral sinus venous thrombosis in children: a retrospective review

Cerebral sinus venous thrombosis (CSVT) is a rare but serious complication of acute mastoiditis in children. Early diagnosis is often delayed due to nonspecific symptoms. This study aimed to identify clinical and laboratory predictors of CSVT in children with mastoiditis to support timely imaging and treatment. We performed a retrospective case–control study across two university-affiliated centers from 1999 to 2022 of children with acute mastoiditis who underwent neuroimaging. Clinical, laboratory, imaging, and treatment data from 81 children (40 with CSVT and 41 without) were compared. Logistic regression was used to identify predictors of CSVT. Four variables were independently associated with CSVT: abnormal neurologic findings (OR 18.24, 95% CI 3.12–150.62, p < 0.01), persistent fever > 72 h despite antibiotic treatment (OR 4.67, 95% CI 1.23–19.92, p = 0.03), prior antibiotic use (OR 4.74, 95% CI 1.27–21.16, p = 0.03), and elevated C-reactive protein (CRP) levels (OR 1.14 per mg/dL, 95% CI 1.05–1.27, p = 0.03). The model had strong discrimination (AUC = 0.85). Thrombus resolution was documented in 25 of 32 children (median, 3.8 months). Anticoagulation was safe and effective. Thrombophilia testing had limited diagnostic yield. Conclusion: Abnormal neurologic signs, prolonged fever, elevated CRP, and recent antibiotic use are key predictors of CSVT in pediatric mastoiditis. Early imaging and timely anticoagulation contribute to favorable outcomes. Routine thrombophilia screening may have limited utility. These findings may help general pediatricians identify children who need timely referral for neuroimaging and specialist care. (Table presented.)