Early Identification and Management of Otogenic and Nonotogenic Cerebral Venous Sinus Thrombosis

Objective: Cerebral venous sinus thrombosis (CVST) is a rare and life-threatening condition. Treatment strategies vary significantly based on etiological factors, yet literature on etiological classification remains limited. This study aims to delineate the clinical differences between otogenic and nonotogenic CVST to inform etiology-specific management and therapeutic decision-making. Methods: We conducted a retrospective analysis of 39 CVST cases (9 otogenic, 30 nonotogenic) admitted to Fujian Medical University Union Hospital between December 2020 and December 2024. Key variables assessed included etiology, clinical presentation, imaging characteristics, and treatment regimens. Results: Magnetic resonance venography (MRV) effectively diagnosed CVST (sensitivity 97.44%). Otogenic CVST exhibited a significantly higher incidence of retroauricular erythema (100% vs. 0%, P <0.05), was more frequently unilateral (100% vs. 40%, P <0.05) and localized to a single venous sinus (66.7% vs. 26.7%, P <0.05), and demonstrated significantly lower D-dimer levels (0.67 vs. 3.53 mg/L, P <0.05). The optimal diagnostic threshold for D-dimer was 0.767 mg/L. After standardized treatment, the improvement rate was 100% for otogenic CVST, compared with 83.3% for nonotogenic CVST, which had a mortality rate of 6.7%. At the 6-month follow-up, otogenic CVST patients showed good postoperative recovery and resumed daily activities; imaging in 4 cases revealed complete venous sinus recanalization. Among nonotogenic CVST patients, 2 deaths occurred, and 3 experienced recurrent headaches postdischarge, resulting in an improvement rate of 83.3%. Conclusion: Early and accurate differentiation enables effective intervention: otogenic CVST requires prompt surgical management of the primary otological infection, whereas nonotogenic CVST necessitates personalized anticoagulation therapy. D-dimer testing combined with MRV and clinical assessment of otological symptoms can facilitate reliable etiological differentiation. Levels of Evidence: Level IV.