RESUMEN
Cerebellar atrophy is a rare and challenging disease with few descriptions in the medical literature. Motor impairment is mild, but behavioral and linguistic alterations stand out, in what is known as the cerebellar cognitive affective syndrome secondary to cerebellar atrophy. We report the case of an older woman with early-onset (age 45) signs and symptoms of this syndrome, including impairment of executive functions and visuospatial cognition, personality changes, and language deficits, who was followed at a geriatric medical center for 14 years. Neuropsychological, imaging, and behavioral aspects during this period are discussed in light of scientific evidence. This case report contributes to the scientific literature by describing the progression of the signs and symptoms of cerebellar atrophy over the years, which can help guide medical management and support advice for patients and their families.
A atrofia cerebelar é uma doença rara, desafiadora e com poucas descrições na literatura médica. O prejuízo motor é discreto, mas as alterações comportamentais e de linguagem se destacam, caracterizando a síndrome cognitivo-afetiva cerebelar secundária à atrofia cerebelar. Apresentamos o relato de caso de uma paciente idosa, que apresentou sinais e sintomas dessa síndrome precocemente (aos 45 anos de idade) tais como déficits na função executiva, prejuízo visuoespacial, alterações de personalidade e déficits de linguagem e foi acompanhada em um centro médico geriátrico por um período de 14 anos. Aspectos neuropsicológicos, de imagem e comportamentais durante esse período são comentados à luz das evidências científicas. O caso relatado contribui com a literatura científica ao descrever a evolução dos sinais e sintomas da atrofia cerebelar ao longo dos anos, balizando as condutas médicas e amparando as orientações ao paciente e seus familiares.
Asunto(s)
Humanos , Femenino , Anciano , Enfermedades Cerebelosas/complicaciones , Trastornos del Conocimiento/etiología , Trastornos del Humor/etiología , Síndrome , Imagen por Resonancia Magnética , Enfermedades Cerebelosas/diagnóstico por imagen , Estudios de SeguimientoRESUMEN
TITLE: Hemicerebelitis por chikungunya asociado a estado epiléptico refractario en edad pediátrica.
Asunto(s)
Enfermedades Cerebelosas/etiología , Fiebre Chikungunya/complicaciones , Estado Epiléptico/etiología , Enfermedad Aguda , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/líquido cefalorraquídeo , Anticonvulsivantes/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/etiología , Déficit de la Atención y Trastornos de Conducta Disruptiva/etiología , Daño Encefálico Crónico/etiología , Enfermedades Cerebelosas/diagnóstico por imagen , Fiebre Chikungunya/sangre , Fiebre Chikungunya/líquido cefalorraquídeo , Virus Chikungunya/inmunología , Preescolar , Resistencia a Medicamentos , Disartria/etiología , Humanos , Inmunoglobulina M/sangre , Inmunoglobulina M/líquido cefalorraquídeo , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Paresia/etiología , Fenobarbital/uso terapéutico , Estado Epiléptico/tratamiento farmacológicoRESUMEN
BACKGROUND: Symptomatic Chiari Type I Malformation (CM) is treated with posterior fossa decompression with or without duroplasty. We have noticed some cases with concomitant severe cerebellar ataxia due to cerebellar atrophy. The aim of this study is to review the literature of CM associated with severe cerebellar atrophy and discuss its potential physiopathology. METHODS: A systematic literature review in the Pubmed Database was performed using the following key-terms: "cerebellar atrophy Chiari", and "cerebellar degeneration Chiari". Articles reporting the presence of cerebellar degeneration/atrophy associated with CM were included. RESULTS: We found only six studies directly discussing the association of cerebellar atrophy with CM, with a total of seven cases. We added one case of our own practice for additional discussion. Only speculative causes were described to justify cerebellar atrophy. The potential causes of cerebellar atrophy were diffuse cerebellar ischemia from chronic compression of small vessels (the most mentioned speculative cause), chronic raised intracranial pressure due to CSF block, chronic venous hypertension, and association with platybasia with ventral compression of the brainstem resulting in injury of the inferior olivary nuclei leading to mutual trophic effects in the cerebellum. Additionally, it is not impossible to rule out a degenerative cause for cerebellar atrophy without a causative reason. CONCLUSIONS: Severe cerebellar atrophy is found in some patients with CM. Although chronic ischemia due to compression is the most presumed cause, other etiologies were proposed. The real reasons for cerebellar degeneration are not known. Further studies are necessary.
Asunto(s)
Malformación de Arnold-Chiari/fisiopatología , Enfermedades Cerebelosas/fisiopatología , Malformación de Arnold-Chiari/diagnóstico por imagen , Atrofia , Enfermedades Cerebelosas/diagnóstico por imagen , Cerebelo/anomalías , Cerebelo/fisiopatología , Cerebelo/cirugía , Descompresión Quirúrgica , Femenino , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
SUMMARY BACKGROUND Symptomatic Chiari Type I Malformation (CM) is treated with posterior fossa decompression with or without duroplasty. We have noticed some cases with concomitant severe cerebellar ataxia due to cerebellar atrophy. The aim of this study is to review the literature of CM associated with severe cerebellar atrophy and discuss its potential physiopathology. METHODS A systematic literature review in the Pubmed Database was performed using the following key-terms: "cerebellar atrophy Chiari", and "cerebellar degeneration Chiari". Articles reporting the presence of cerebellar degeneration/atrophy associated with CM were included. RESULTS We found only six studies directly discussing the association of cerebellar atrophy with CM, with a total of seven cases. We added one case of our own practice for additional discussion. Only speculative causes were described to justify cerebellar atrophy. The potential causes of cerebellar atrophy were diffuse cerebellar ischemia from chronic compression of small vessels (the most mentioned speculative cause), chronic raised intracranial pressure due to CSF block, chronic venous hypertension, and association with platybasia with ventral compression of the brainstem resulting in injury of the inferior olivary nuclei leading to mutual trophic effects in the cerebellum. Additionally, it is not impossible to rule out a degenerative cause for cerebellar atrophy without a causative reason. CONCLUSIONS Severe cerebellar atrophy is found in some patients with CM. Although chronic ischemia due to compression is the most presumed cause, other etiologies were proposed. The real reasons for cerebellar degeneration are not known. Further studies are necessary.
RESUMO OBJETIVO A Malformação de Chiari (MC) tipo I sintomática é tratada através da descompressão da fossa posterior com ou sem duroplastia. Observamos alguns casos com ataxia cerebelar grave concomitante devido à atrofia cerebelar. O objetivo deste estudo é revisar a literatura sobre MC associada à atrofia cerebelar grave e discutir sua possível fisiopatologia. METODOLOGIA Conduzimos uma revisão sistemática da literatura no banco de dados Pubmed utilizando as seguintes palavras-chave: "cerebellar atrophy Chiari", e "cerebellar degeneration Chiari". Artigos sobre a presença de degeneração/atrofia cerebelar associada à MC foram incluídos. RESULTADOS Encontramos apenas seis estudos que discutiam diretamente a associação entre atrofia cerebelar e MC, com um total de sete casos. Nós adicionamos um caso da nossa própria prática para ampliar a discussão. Apenas causas especulativas foram descritas para justificar a atrofia cerebelar, entre elas: isquemia cerebelar difusa devido à compressão crônica de pequenos vasos (a causa especulativa mais citada), pressão intracraniana elevada crônica devido ao bloqueio de LCR, hipertensão venosa crônica e associação com platibasia com compressão ventral do tronco cerebral, resultando em lesão do núcleo olivar inferior e levando a efeitos tróficos mútuos no cerebelo. Além disso, não é possível descartar uma causa degenerativa para atrofia cerebelar sem motivos claros. CONCLUSÃO A atrofia cerebelar grave é encontrada em alguns pacientes com MC. A isquemia crônica causada por compressão é a causa mais apontada como suspeita, porém outras etiologias foram propostas. As reais causas da degeneração cerebelar não são conhecidas. Mais estudos são necessários.
Asunto(s)
Humanos , Masculino , Femenino , Malformación de Arnold-Chiari/fisiopatología , Enfermedades Cerebelosas/fisiopatología , Malformación de Arnold-Chiari/diagnóstico por imagen , Atrofia , Imagen por Resonancia Magnética , Enfermedades Cerebelosas/diagnóstico por imagen , Cerebelo/anomalías , Cerebelo/cirugía , Cerebelo/fisiopatología , Descompresión QuirúrgicaRESUMEN
Cerebellar ataxias are a clinically heterogeneous group of neurological disorders. Besides the cerebellum, several forms of hereditary ataxias or non-genetic ataxias also affect other areas of the brain. Some forms of cerebellar ataxias may have cochlear and vestibular involvement and may present with deafness and symptoms or signs of vestibulopathy (dizziness, nystagmus and diplopia). Recognizing otoneurological symptoms in patients with cerebellar ataxias is mandatory, since these signs may guide a specific diagnosis, and clinicians may provide a suitable therapeutic approach. In this review, we describe and discuss the most common forms of cerebellar ataxias associated with deafness and vestibulopathy.
Asunto(s)
Ataxia Cerebelosa/diagnóstico por imagen , Cerebelo/diagnóstico por imagen , Sordera/diagnóstico por imagen , Vestíbulo del Laberinto/diagnóstico por imagen , Animales , Ataxia Cerebelosa/epidemiología , Enfermedades Cerebelosas/diagnóstico por imagen , Cerebelo/fisiología , Sordera/epidemiología , Humanos , Vestíbulo del Laberinto/fisiologíaRESUMEN
Case presentation of acute cerebellitis caused by herpes simplex virus.
Asunto(s)
Humanos , Femenino , Adulto , Enfermedades Cerebelosas/tratamiento farmacológico , Enfermedades Cerebelosas/diagnóstico por imagen , Simplexvirus/efectos de los fármacos , Simplexvirus/patogenicidad , Enfermedades Cerebelosas/diagnósticoRESUMEN
Zika virus (ZIKV) was first detected in the Americas in Brazil in 2015, with a rapid spread to surrounding countries. In Panama, the outbreak began in November 2015 in an indigenous community located on the Caribbean side of the country. Zika virus is typically associated with a diffuse rash, fever, and conjunctivitis. It can rarely cause neurologic manifestations, most commonly microcephaly and Guillain-Barré syndrome. Encephalitis and acute encephalomyelitis are known complications, but ZIKV-associated cerebellitis has yet to be reported in the literature. Herein, we report a case of cerebellitis in a patient infected with ZIKV. This patient developed severe frontal headache and vertigo on the third day of illness, and dysarthria and ataxia on the fifth day. After 1 week of hospitalization, the patient completely recovered. The laboratory serological diagnosis was complicated because of the detection of antibodies against dengue, suggesting a secondary flavivirus infection.
Asunto(s)
Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/virología , Infección por el Virus Zika/complicaciones , Adulto , Anticuerpos Antivirales/sangre , Ataxia/virología , Brasil , Enfermedades Cerebelosas/terapia , Coinfección/diagnóstico , Coinfección/virología , Dengue/diagnóstico , Femenino , Infecciones por Flavivirus/diagnóstico , Cefalea/virología , Hospitalización , Humanos , Reacción en Cadena de la Polimerasa , ARN Viral/genética , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vértigo/virología , Virus Zika/genética , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/diagnósticoRESUMEN
As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.
Asunto(s)
Ataxia/etiología , Hipersensibilidad a los Alimentos/complicaciones , Glútenes/efectos adversos , Glútenes/inmunología , Miastenia Gravis/etiología , Adulto , Ataxia/diagnóstico , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/etiología , Inhibidores de la Colinesterasa/uso terapéutico , Femenino , Hipersensibilidad a los Alimentos/diagnóstico , Humanos , Imagen por Resonancia Magnética , Miastenia Gravis/diagnóstico , Neuroinmunomodulación , Bromuro de Piridostigmina/uso terapéutico , Deficiencia de Vitamina B 12/complicacionesRESUMEN
SUMMARY As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.
Asunto(s)
Humanos , Femenino , Adulto , Ataxia/etiología , Hipersensibilidad a los Alimentos/complicaciones , Glútenes/efectos adversos , Glútenes/inmunología , Miastenia Gravis/etiología , Bromuro de Piridostigmina/uso terapéutico , Ataxia/diagnóstico , Deficiencia de Vitamina B 12/complicaciones , Imagen por Resonancia Magnética , Neuroinmunomodulación , Enfermedades Cerebelosas/etiología , Enfermedades Cerebelosas/diagnóstico por imagen , Inhibidores de la Colinesterasa/uso terapéutico , Hipersensibilidad a los Alimentos/diagnóstico , Miastenia Gravis/diagnósticoAsunto(s)
Humanos , Femenino , Niño , Anomalías Múltiples/diagnóstico por imagen , Enfermedades Cerebelosas/diagnóstico por imagen , Mesencéfalo/anomalías , Mesencéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética , Cerebelo/anomalías , Cerebelo/diagnóstico por imagen , Fosa Craneal Posterior/anomalías , Fosa Craneal Posterior/diagnóstico por imagenRESUMEN
BACKGROUND: There are no population studies estimating the burden of alcoholic cerebellar degeneration (ACD). We aimed to assess prevalence and correlates of ACD among chronic alcohol drinkers living in rural Ecuador. METHODS: Characteristics of alcohol intake were evaluated in community-dwelling men aged ≥40years enrolled in the Atahualpa Project. Cerebellar dysfunction evaluation used the Brief Ataxia Rating Scale (BARS). Association between alcohol intake and the BARS was assessed in generalized linear models adjusted for relevant confounders. In subjects who had CT, the relationship between cerebellar atrophy and the BARS was evaluated. RESULTS: Of the 313 men identified during a door-to-door survey, 246 (79%) were enrolled. All admitted continuous drinking for ≥10years. Of these, 41% started drinking below legal age (18years), 72% were current drinkers, and 83% engaged in binge drinking. Average alcohol intake was 330±351g/week. Mean BARS score was 1.4±2 points, with 14.6% (95% C.I.: 10.8%-19.6%) of individuals having ≥4 points and considered to have clinically relevant ACD. The BARS was associated with years of drinking (p=0.036), amount of alcohol intake (p<0.0001), and binge drinking (p=0.026). Predictive models showed significant relationships between BARS score margins and years of drinking and the amount of alcohol intake, independent of other variables. There was no association between cerebellar atrophy on CT and the BARS in 214 participants. CONCLUSIONS: Prevalence of clinically relevant ACD in this population is low. There are both independent and synergistic effects of years of drinking, amount of alcohol intake and binge drinking in the severity of cerebellar dysfunction.
Asunto(s)
Trastornos Relacionados con Alcohol/epidemiología , Trastornos Relacionados con Alcohol/fisiopatología , Enfermedades Cerebelosas/epidemiología , Enfermedades Cerebelosas/fisiopatología , Adulto , Trastornos Relacionados con Alcohol/diagnóstico por imagen , Enfermedades Cerebelosas/diagnóstico por imagen , Cerebelo/diagnóstico por imagen , Ecuador , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
Cerebellar hemorrhage is listed among the potential complications following neurosurgical procedures. In this scenario it is usually reported as a rare condition. However, it seems that epilepsy surgery patients are somewhat more prone to this kind of complication, compared to other surgical groups. Head positioning, excessive cerebral spinal fluid draining and the excision of non-expanding encephalic tissue (or combinations among the three) are likely to be cause underlying remote cerebellar hemorrhage. Out of the 118 ATL/AH performed at our institution, between 1996 and 2002, we identified 3 (2.5%) patients presenting with cerebellar hemorrhage. We report on such cases and review the literature on the topic.
Asunto(s)
Lobectomía Temporal Anterior , Enfermedades Cerebelosas/etiología , Hemorragia Cerebral/etiología , Epilepsia del Lóbulo Temporal/cirugía , Hemorragia Posoperatoria/etiología , Adulto , Enfermedades Cerebelosas/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Femenino , Humanos , Masculino , Hemorragia Posoperatoria/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
We report a case of cerebellar abscess secondary to chronic otitis and localized in the right cerebellar hemisphere, in a pediatric patient. The abscess was treated only by antibiotic therapy, evolving to complete clinical and radiological resolution, without neurosurgical intervention. We also discuss the pathogenesis, histopathogenesis, clinical manifestations and the forms of treatment of CNS abscesses.
Asunto(s)
Absceso Encefálico/etiología , Enfermedades Cerebelosas/etiología , Otitis Media/complicaciones , Antibacterianos/uso terapéutico , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/tratamiento farmacológico , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/tratamiento farmacológico , Preescolar , Femenino , Humanos , RadiografíaRESUMEN
INTRODUCTION: Praziquantel has not been considered useful for therapy of subarachnoid cysticercosis. However, recent studies suggest that the introduction of a new regimen of praziquantel therapy, that includes the administration of higher doses of the drug at shorter intervals, may improve pharmacokinetic properties of praziquantel and increase its efficacy in this form of the disease. CLINICAL CASE: A 28 year-old woman presented with a six month history of headache, vomiting, nystagmus, right peripheral facial palsy, and left hemiparesis. Computerized tomography (CT) scan of the head revealed a large cysticercus in the right cerebellopontine angle cistern compressing the brain-stem. She was treated with praziquantel 100 mg/kg in three divided doses at two hours apart. Thereafter, she received three 8 mg doses of intravenous dexamethasone given 6, 24 and 48 hours after the last dose of praziquantel. She improved after therapy, with total resolution of hemiparesis. Control CT showed progressive reduction and size and further disappearance of the cystic lesions three months later. CONCLUSION: This single-dose regimen of praziquantel seems to be effective for therapy of subarachnoid cysticercosis. Further studies with a large number of patients are needed to confirm the efficacy of the drug in this form of the disease.
Asunto(s)
Antihelmínticos/administración & dosificación , Enfermedades Cerebelosas/tratamiento farmacológico , Ángulo Pontocerebeloso , Neurocisticercosis/tratamiento farmacológico , Praziquantel/administración & dosificación , Adulto , Enfermedades Cerebelosas/diagnóstico por imagen , Ángulo Pontocerebeloso/diagnóstico por imagen , Femenino , Humanos , Neurocisticercosis/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Infratentorial subdural empyemas are rare. The authors report three cases encountered between 1979 and 1988, representing a 3% incidence among all subdural empyemas. The common source was an ear infection. Clinical presentation encompassed a systemic febrile illness, headaches, and a stiff neck. Only one patient had an inconspicuous focal neurological deficit that suggested a cerebral location. Initial diagnosis was acute meningitis in each case. A lumbar puncture was ordered in all three cases but was actually performed in two without developing tonsillar herniation. Cerebrospinal fluid analysis confirmed the diagnosis of meningitis in one but was normal in the other. Computerized tomography allowed a precise diagnosis and localization of the pathology. All three patients received aggressive antibiotic therapy plus suboccipital craniectomy and aspiration of pus; catheter drainage was performed in two. Cultures were positive in one case and negative in the others. Two patients were cured without sequelae; the third patient was moribund at surgery and died. Although it is known that subdural empyemas may localize in the posterior fossa, only one previous report was found. Infratentorial subdural empyema may sometimes be an unrecognized companion of acute meningitis and is cured with antibiotic therapy alone.
Asunto(s)
Enfermedades Cerebelosas/etiología , Empiema Subdural/etiología , Otitis/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Enfermedades Cerebelosas/diagnóstico por imagen , Diagnóstico Diferencial , Empiema Subdural/diagnóstico por imagen , Humanos , Masculino , Meningitis/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A series of 23 patients with spontaneous cerebellar hematoma is analysed retrospectively. Several degrees of consciousness impairment, and headache occurred in all; 12 patients presented motor deficits among the more important clinical signs. Arterial hypertension (69.5%) and diabetes (34%) stand out in the pathological background, and their association was frequent (30%). Computerized tomography (CT) disclosing severe ventricular dilatation (69.5%) associated or not with intraventricular presence of blood is considered as an unsatisfactory prognosis sign, and indicative for emergency therapy. Emergency external ventricular draining is the best indication for the majority of these cases. Posterior fossa craniectomy for emptying the hematoma may be the indication in severe cases. Death and morbidity in this pathology are high as yet. However, CT contribution for diagnosis is quicker and better than benefits obtained through other methods. Results observed in the present series are illustrative on this statement, when compared to data of other series diagnosed through other methods.
Asunto(s)
Enfermedades Cerebelosas/diagnóstico , Hematoma/diagnóstico , Adulto , Anciano , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/cirugía , Femenino , Hematoma/diagnóstico por imagen , Hematoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Two children with intracranial venous sinus thrombosis complicating mastoiditis prompted review of the experience with these disorders at the The Children's Memorial Hospital in Chicago over the past decade. Fifteen patients, 1.5 to 14 years of age, with mastoiditis were identified, including nine cases categorized as acute and six as chronic, the latter without fever but with chronic otorrhea. All six patients with chronic, but none with acute, mastoiditis were found to have cholesteatomas. Venous sinus thrombosis developed in four children and intracerebellar abscess in one child. Contrast-enhanced computerized tomography has proved valuable in the diagnosis of these rare, serious complications of mastoiditis in recent patients. Arteriography is still desired to confirm venous patency or occlusion prior to surgery because of well-documented developmental variations in venous drainage patterns. Optimal therapy of mastoiditis and its complications generally requires surgical drainage in addition to administration of antibiotics.