TITLE:
Acute Invasive Rhinosinusitis Complicated by Cerebral Venous Sinus Thrombosis: A Case Report and Review of Multidisciplinary Management
AUTHORS:
Ebiuwa Osula, Zain Abideen, Khadija Shajahan, Zaid Arkras, Taha Abubaker, Sowa Graham
KEYWORDS:
Sinusitis, Mastoiditis, Cerebral Venous Thrombosis, Intracranial Complications, MR Venography, Multidisciplinary Management
JOURNAL NAME:
World Journal of Neuroscience,
Vol.16 No.1,
February
10,
2026
ABSTRACT: Acute sinusitis is common, but intracranial complications such as cerebral venous thrombosis (CVT), meningitis, and brain abscesses are rare and potentially life-threatening. Early recognition and multidisciplinary management are critical, particularly in immunocompromised or medically complex patients. We report a 68-year-old male with a history of mantle cell lymphoma, hypertension, and chronic tobacco use, who presented with a three-day history of right-sided headache and intermittent tinnitus. He had recently been treated for herpes simplex virus type 1 with acyclovir, which he discontinued due to persistent symptoms, and was concurrently being treated for right-sided mastoiditis. Despite multiple prior emergency visits, his symptoms persisted. Initial imaging revealed right tympanic membrane opacity and opacification of the right mastoid air cells and middle/external ear, consistent with mastoiditis. MRI of the brain and MR venography confirmed thrombosis of the right transverse and sigmoid sinuses. Lumbar puncture demonstrated lymphocytic predominance consistent with viral meningitis. The patient was treated with empiric broad-spectrum antibiotics, corticosteroids, and anticoagulation, and later transitioned to apixaban. Multidisciplinary management involved neurology, otolaryngology, infectious disease, and hematology teams. This case highlights that subtle neurological symptoms, such as isolated headache or tinnitus, may indicate serious intracranial complications of sinusitis. Advanced imaging, particularly MRI and MR venography, is essential for early detection. Coordinated multidisciplinary care, timely therapeutic intervention, and awareness of atypical presentations in high-risk patients are vital to improve outcomes and prevent potentially fatal sequelae.