Transcript
Case series:
INTRODUCTION
Otogenic intracranial abscesses are an uncommon but life-threatening complication of otitis media
This study is to recognizing this complication as well as provide some
information about the disease process and management.
• Here it is a case series at our hospital of 3 patients with diagnosis of otogenic brain abscess.
CASE-1
• Pt• Female- 27y
• Left Ear Discharge – childhood, Insidious onset, progressive in nature, whitish, foul smell& intermittent.
• Left Ear Pain- One month, more during discharge, progressive, piercing in nature , continuous through the day, fever
• Head ache since 1 month
History cont…
• No significant Personal/Family History.• General Examination:-• Pulse-87/mint. • RS-clear.• CVS-S1,S2+.• CNS-GCS-15/15.• Abd-Soft
Local Examination:-Ear
Left Ear• Pinna/Pre&Post auricular:- • Normal• Tenderness:-• No• E.A.C:-• Granulation +• TM:-• Granulations +, Whitish
Debry + at Attic Area
• FISTULA TEST:-• -VE
Right Ear
• Normal
• No
• Normal
• Normal
• -VE
Tuning Fork Test:-• Rinne’s Test:- BC>AC• Weber Test:- Lateralised to Left
• ABC Test:- Not reduced• PTA:- 26.6db Mild conductive hearing loss
AC>BC
Not reduced
18.3db
• Nose/Throat :- Normal• Investigations:-• Surgical Profile-within Normal limitis
MRI Scan Brain & Temporal Bones:-Thick Walled Hypo dense Ring Enhancing lesion in Left
Temporal Region with Left mastoiditis and No Significant mass effect or Midline shift
Diagnosis:-Lt CSOM – SQUAMOSAL TYPE with OTOGENIC BRAIN ABSCESS
CASE-2
Age/Sex:- 10y/M, • Discharge from Right Ear –Childhood,
• Pain in Right Ear-One Month,
• Swelling over Right Temporal Region-One Month,
• Vertigo – One Month,
• Fever – One Month.
• Pt had history of altered sesorium,drowseness,vomitings
• No significant Personal/Family History.• General Examination:-• Pt conscious/coherent/well oriented.• Pulse-92. • RS-clear.• CVS-S1,S2.• CNS-GCS-15/15.• Abd-Soft
Local Examination:-Ear
Right Ear• Pinna/Pre&Post auricular:- • Normal• Tenderness:-• Over Mastoid process
&Conchae• E.A.C:-• Oedematous,Granulations +• TM:-• Granulations +, Remnant of
T.M with Annulus• FISTULA TEST:-• -VE
Left Ear• Normal
• No
• Normal
• Normal
• -VE
Tuning Fork Test:-• Rinne’s Test:- BC>AC• Weber Test:- Lateralised to Right• ABC Test:- Not reduced• PTA:- 35db Mild conductive
hearing loss
CT Scan Brain & Temporal Bones:-Thick Walled Hypo dense Ring Enhancing lesion in Right
Parietal Region with Significant mass effect and Midline shift with Right mastoiditis
Diagnosis:-Rt CSOM –SQUAMOSAL with OTOGENIC BRAIN ABSCESS
CASE 3Male-46yPresented with:Right ear discharge 5yrs
Head ache -2months
Nausea -2months
Generalised body weakness-1month
Local Examination:-Ear
Right Ear• Pinna/Pre&Post auricular:- • Normal• Tenderness:-• no• E.A.C:-• normal• TM:-• STP+ATTIC
RETRACTION GRANULATION+
• FISTULA TEST:-• -VE
Left Ear• Normal
• No
• Normal
• Normal
• -VE
Tuning Fork Test:-• Rinne’s Test:- BC>AC• Weber Test:- Lateralised to Right• ABC Test:- Not reduced• PTA:- 44.6db moderate conductive
hearing loss
Ct scan showing ring enhanced lesion in Rt temporal region with midline shift
Diagnosis : Rt CSOM SQUAMOSAL type with Rt temporal abscess.
MANAGEMENT
all the 3 patients were managed with
3wks IV antibiotics
Followed by excision & drainage of brain abscess. by craniotomies/burr hole drainage.
• MODIFIED RADICAL MASTOIDECTOMY.
• 3 pts were tolerated the procedure well, no mortality were recorded
• . No pt reported with recurrence of intra cranial complications
OTOGENIC BRAIN ABSCESS
DEFINITION : Brain abscess is a focal suppurative process within the brain
parenchyma surrounded by a region of Inflammation
OTOGENIC BRAIN ABSCESS
50-75 % adult brain abscess & 25% in child is otogenic.
Temporal abscess is twice as common as cerebellar abscess
Mortality associated with otogenic brain is around 25%.in preantibiotic
era
ROUTES OF INFECTION:
1.Direct spread:
via Tegmen plate: Temporal abscess via Trautmann’s triangle: Cerebellar abscess
2. Retrograde spread: via thrombophlebitis•
sometimes the infection could extend via the Virchow -Robin spaces in to the cerebral white matter.
Trautmann's triangle. It is Pathway to posterior cranial fossa from mastoid cavity
STAGES OF BRAIN ABSCESSs
1-10DAYS
10-14
>14Days
Bacteriology
• Anaerobic streptococci
• Streptococcus pneumoniae
• Staphylococci
• Proteus
• E. coli
• Pseudomonas
• Bacteroidis fragilis
CLINICAL FEATURES• Patient looks very toxic & drowsy.• Deep boring headache with projectile vomiting• Foul-smelling creamy otorrhea indicates a
fulminant destructive process.TRIAD OF BRAIN ABSCESS:
Headache.
High grade fever
Symptoms due to focal neurological deficits
CONCLUSION
Diagnosis should be considered in all such patients presenting with a ear discharge, headache, fever, seizures and confusion, especially after failing conservative treatment
OBA remains a life-threatening condition requires prolonged systemic antimicrobial therapy surgical intervention.
It is recommended to evaluate such cases by imaging to rule
out brain abscess ,to reduce mortality & morbidity.
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