Case series otogenic brain abcess

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.