Lateral Sinus Thrombophlebitis

Lateral Sinus Thrombophlebitis

Q. 1

Grisengers sign is seen in:

 A

Cavernous sinus thrombosis

 B

Superior sagittal sinus thrombosis

 C

Inferior sagittal sinus thrombosis

 D

Lateral sinus thrombosis

Q. 1

Grisengers sign is seen in:

 A

Cavernous sinus thrombosis

 B

Superior sagittal sinus thrombosis

 C

Inferior sagittal sinus thrombosis

 D

Lateral sinus thrombosis

Ans. D

Explanation:

Q. 2

Tober Ayer test is positive in:

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid hemorrhage 

Q. 2

Tober Ayer test is positive in:

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid hemorrhage 

Ans. A

Explanation:

Q. 3

Lateral sinus thrombosis is asso­ciated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily crowe sign

 D

Tobey Ayer test

Q. 3

Lateral sinus thrombosis is asso­ciated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily crowe sign

 D

Tobey Ayer test

Ans. A

Explanation:

Q. 4

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Q. 4

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Ans. B

Explanation:

Canal wall down mastoidectomy is done in cases of attic cholesteatoma. In this procedure mastoid cavity is left open into the external auditory canal.

Since the patient in the question is suffering from attic cholesteatoma and secondary complications canal wall down mastoidectomy would be the treatment of choice.

Other indications of this procedure includes extensive chronic otits media, formation of a new attic retraction pocket with disease following a previously performed canal wall up procedure, lateral semicircular canal fistula in the only hearing ear.


Q. 5

A patient with ear discharge presents with diplopia and fever. What is the most probable diagnosis?

 A

CSOM

 B

Meningitis

 C

Lateral sinus thrombosis

 D

Petrositis

Q. 5

A patient with ear discharge presents with diplopia and fever. What is the most probable diagnosis?

 A

CSOM

 B

Meningitis

 C

Lateral sinus thrombosis

 D

Petrositis

Ans. C

Explanation:

Presence of fever and diplopia in a patient with ear discharge suggests lateral sinus thrombosis, an intracranial complication of chronic suppurative ottitis media. 


Q. 6

‘Griesinger sign’ is otalgia along with pain and edema over mastoid. It is typically seen in:

 A

Lateral sinus thrombosis

 B

Acoustic neuroma

 C

Otosclerosis

 D

CSOM

Q. 6

‘Griesinger sign’ is otalgia along with pain and edema over mastoid. It is typically seen in:

 A

Lateral sinus thrombosis

 B

Acoustic neuroma

 C

Otosclerosis

 D

CSOM

Ans. A

Explanation:

  • Lateral sinus thrombosis is a ominous complication of acute OM. It arises from extension of infection and inflammation in the mastoid, with eventual inflammation of the adjacent lateral or sigmoid sinus.
  • Headache is the most common symptom, with papilledema, sixth-nerve palsy, and vertigo being less frequently present.
  • Occlusion of the lateral sinus produces pain over the ear and mastoid and may cause edema over the mastoid (Griesinger sign). 
  • Involvement of cranial nerves V and VI produces ipsilateral facial pain and lateral rectus weakness (Gradenigo syndrome).

Q. 7

Griesinger’s sign is observed in which of the following condition?

 A

Abducent nerve paralysis

 B

Otosclerosis

 C

Lateral sinus thrombosis

 D

Petrositis

Q. 7

Griesinger’s sign is observed in which of the following condition?

 A

Abducent nerve paralysis

 B

Otosclerosis

 C

Lateral sinus thrombosis

 D

Petrositis

Ans. C

Explanation:

Griesinger’s sign: Erythema and oedema posterior to the mastoid process resulting from septic thrombosis of the mastoid emissary vein. It is seen in lateral sinus thrombosis.


Q. 8

Which of the following CNS condition shows positive Tober Ayer test?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Q. 8

Which of the following CNS condition shows positive Tober Ayer test?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Ans. A

Explanation:

Tober Ayer test is positive in lateral sinus thrombosis or sigmoid sinus thrombosis. This test is to record CSF pressure by manometer and to see the effect of manual compression of one or both jugular veins. Compression on vein on the thrombosed side produces no effect while compression of vein on healthy side produces rapid rise in CSF pressure which will be equal to bilateral compression of jugular veins.
 
 
 
Clinical features of lateral sinus thrombosis:
  • Hectic Picket-fence type of fever with rigors
  • Headache
  • Progressive anemia and emaciation
  • Griesinger’s sign
  • Papilloedema
  • Tober Ayer test
  • Crowe-Beck test
  • Tenderness along jugular vein

Q. 9

Tober Ayer’s test is positive in which of the following condition?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Q. 9

Tober Ayer’s test is positive in which of the following condition?

 A

Lateral sinus thrombosis

 B

Petrositis

 C

Cerebral abscess

 D

Subarachnoid haemorrhage

Ans. A

Explanation:

Positive Queckenstedt test or Tobey Ayer test is present in lateral sinus thrombosis. It refers to a   lack of increase in CSF pressure during compression of internal jugular vein ipsilateral to a thrombosed lateral sinus.

 
It can also be diagnosed by CT scan or MRI. MR venogram is helpful in showing the degree of thrombus extension within the venous system. 
 
Patients presents with low grade intermittent fever, that can progress to a spiking, picket fence pattern secondary to the dissemination of septic emboli into the systemic circulation. They can also develop torticollis and neck tenderness particularly along the course of internal jugular vein. 
 

 


Q. 10

Lateral sinus thrombosis is associated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily-Crowe sign

 D

Tobey Ayer test

Q. 10

Lateral sinus thrombosis is associated with all except:

 A

Greisinger sign

 B

Gradenigo sign

 C

Lily-Crowe sign

 D

Tobey Ayer test

Ans. B

Explanation:

Q. 11

Griesinger’s sign is seen in:

 A

Lateral sinus thrombosis 

 B

Meningitis

 C

Brain abscess

 D

Cerebellar abscess

Q. 11

Griesinger’s sign is seen in:

 A

Lateral sinus thrombosis 

 B

Meningitis

 C

Brain abscess

 D

Cerebellar abscess

Ans. A

Explanation:

Q. 12

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Q. 12

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Ans. C

Explanation:

In Attic cholesteatoma, if it invades eustachian tube or perilabyrynthine tissue, then manage­ment is Radial Mastoidectomy. 


Q. 13

Presence of delta sign on contrast enhanced CT SCAN suggests presence of ‑

 A

Lateral Sinus thrombophlebitis

 B

Cholesteatoma

 C

Cerebellar abscess

 D

Mastoiditis

Q. 13

Presence of delta sign on contrast enhanced CT SCAN suggests presence of ‑

 A

Lateral Sinus thrombophlebitis

 B

Cholesteatoma

 C

Cerebellar abscess

 D

Mastoiditis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lateral Sinus thrombophlebitis

LATERAL SINUS THROMBOPHLEBITIS (SIGMOID SINUS THROMBOSIS)

Lateral or sigmoid sinus thrombophlebitis arises from inflammation in the adjacent mastoid. It may occur as a complication of : ‑

  1. Acute coalescent mastoiditis
  2. CSOM and cholesteatoma

Clinical features

  • Hectic Picket-Fence type of fever with rigor.
  • Headache, Progressive anemia and emaciation.
  • Griesinger’s sign : – odema over the posterior part of mastoid due to thrombosis of mastoid emissary veins.
  • Papilloedema
  • Tobey-Ayer test :- Compression of vein on the thrombosed side produces no effect while compression of vein on healthy side produces rapid rise in CSF pressure which will be equal to bilateral compression of jugular veins.
  • Crowe-Beck test :- Pressure on jugular vein of healthy side produces engorgement of retinal veins. Pressure on affected side does not produce such change.
  • Tenderness along jugular vein
  • Imaging studies
  • Contrast-enhanced CT scan can show sinus thrombosis by typical delta-sign. It is a triangular area with rim enhancement, and central low density area is seen in posterior cranial fossa on axial cuts.
  • Delta-sign may also be seen on contrast enhanced MRI.


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