A 2-year-old previously well child presented to the emergency department with temperatures and lethargy. He was pale and looked unwell. He received a fluid bolus and was commenced on intravenous ceftriaxone. Pus was discharging from his left ear with postauricular swelling and erythema. Given clinical concerns, urgent neuroimaging was arranged.
Question 1 What does the CT scan of head show (figure 1)?
Acute subdural collection
Acute mastoiditis secondary to sinusitis
Enhanced cerebral lesions
Meningitis with abscess formation
Middle ear infection with skull base osteomyelitis
A subsequent MRI scan was performed (figure 2).
Question 2 What do these two images show?
Left jugular vein dissection with subdural haematoma
Left jugular vein thrombus and carotid artery occlusion
Posterior fossa tumour
Right sided posterior communicating artery aneurysm
Skull base abscess
Question 3 What is the most likely diagnosis?
Acute mastoiditis secondary to chronic sinusitis
Cerebral tuberculosis (TB)
Hereditary thrombophilia (protein S deficiency)
Non-accidental head trauma (NAI)
Question 4 What is the most commonly identified organism in this syndrome?
Answers can be found on page XX.
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Contributors M-BT, SM, LS and AT were involved in concept, manuscript design and serial draft reviews. M-BT, SM, LS and PM were involved in patient management.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.