An unusual presentation of Griesinger's sign in lateral sinus thrombosis

Abstract

Introduction: Lateral sinus thrombosis (LST), a life-threatening complication of otitis media.The tender and edematous swelling or abscess at the area of exit of the emissary vein behind the mastoid process known as Griesinger’s sign is a pathognomonic sign for lateral sinus thrombosis. The subperiosteal abscess as a feature of Griesinger's sign may be a very rare presentation. Case Presentation: We report a case of 14 -year- old female presented with right sided cholesteatoma with lateral sinus thrombosis with meningitis with Griesinger's sign. Contrast-enhanced T1-weighted Magnetic Resonance Imaging (MRI) shows thrombosis of right lateral sinus, abscess in the postauricular region at the exit of mastoid emissary vein, and patent mastoid emissary vein connecting the lateral sinus and abscess. Discussion: Griesinger’s sign usually results from reflex thrombosis of the mastoid emissary vein in lateral sinus thrombosis. It may rarely manifest with direct venous spread of infection with subperiosteal abscess in the post-auricular region. Contrast-enhanced MRI can help differentiate the edematous swelling or abscess presentation of Griesinger’s sign in lateral sinus thrombosis and its possible pathogenesis.

Keywords

• Lateral sinus thrombosis
• Griesinger’s sign
• Subperiosteal abscess
• Mastoid emissary vein
• Cholesteatoma