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P45 Background: Lateral venous sinus thrombosis can be  associated with mastoiditis. We encountered several cases of lateral  sinus thrombosis associated with MRI abnormalities in the ipsilateral  mastoid air sinus that had no clinical evidence of mastoiditis. The  relationship between lateral sinus thrombosis and mastoid abnormalities  was evaluated systematically.Method: The clinical records  and radiology of all adult cases of cerebral venous sinus thrombosis  (CVT) diagnosed or treated at Auckland Hospital 1990–1999 were  reviewed retrospectively.Results: Twenty-six cases of CVT  were identified. Thrombosis was present in 23 lateral sinuses in 20  cases. Mastoid abnormalities were detected ipsilateral to nine of 23  thrombosed lateral sinuses (39%) and were associated with none of 29  unaffected lateral sinuses (p&lt;0.001). Clinical evidence of mastoiditis  was not present in any case. One case with mastoid abnormality and  lateral sinus thrombosis received antibiotics; eight did not. All made  uneventful recoveries. Reversal of the MRI abnormality after  anticoagulation but without antibiotic treatment was demonstrated.Conclusion: Lateral venous sinus thrombosis is commonly  associated with ipsilateral MRI abnormalities in the mastoid air sinus.  These abnormalities are most likely to be due to venous congestion as a  consequence of venous thrombosis and do not inevitably represent  infective mastoiditis. Patients presenting with lateral sinus  thrombosis and mastoid congestion should have a thorough clinical  assessment for the presence of mastoiditis. When there is no clinical  evidence of infection, treatment should be directed at the underlying  cerebral venous thrombosis; additional treatment with antibiotics is  not required.

Lateral venous sinus thrombosis associated with MRI abnormalities in the mastoid air sinus.