Otitic Hydrocephalus or Obstructive Hydrocephalus?

Dear Editor: I came across the article entitled “Fatal Otitic Hydrocephalus Due to Sinus Thrombosis : A Case Report”, and I would like to thank the authors for sharing their experience with this case. In their discussion, the authors state that otitic hydrocephalus “is characterized by increased intracranial pressure with clear CSF, transient sixth nerve palsy, headache, vomiting, papilledema with no other detectable CNS signs and no actual dilation of ventricles.” They go on to state that “otitic hydrocephalus is a misnomer according to some because it may occur in the absence of otitis and because patients do not show the ventricular dilatation seen in true hydrocephalus.” Lastly, they state that “the diagnosis of OH is made by exclusion and a brain abscess should be ruled out by CT scan.” However, in the description of their case, the authors state the following:1)“Lumbar tap showed elevated cerebrospinal fluid (CSF) opening pressure of 270 mm H2O, decreased glucose and increased protein content” 2) “Repeat CT scan on the second post-op day showed marked dilatation of the third and lateral ventricles due to compression of the fourth ventricle...”3) “He underwent ventriculostomy and evacuation of abscess on the fourth post-operative day.” These statements contradict the main diagnostic features of otitic hydrocephalus, and thus call into question the diagnosis of otitic hydrocephalus in this particular case. In fact, the clinical data points to the presence of an obstructive hydrocephalus. There is no doubt that the patient has evidence of lateral sinus thrombophlebitis. However, not all cases of lateral sinus thrombophlebitis are associated with otitic hydrocephalus.