Cerebellar abscess secondary to mastoiditis

Case contributed by Dr Ian Bickle

Presentation

Young adult with learning difficulties presents moribund with a fever.

Patient Data

Age: 25 years
Gender: Male

Huge ring enhancing cystic lesion with perilesional edema in the left cerebellar hemisphere, which is displacing and effacing the 4th ventricular with a resultant triventricular hydrocephalus.

The cerebellar tonsils herniate inferiorly due to mass effect.

The left mastoid air cell are opacified as is the middle ear with partial destruction of the ossicular chain.

The petrous temporal bone contains a mixture of lucent and sclerotic with destruction of the medial cortex close to the petrous apex.

Case Discussion

An extreme example of two pathologies. A profound mastoiditis with intracranial extension, causing a huge cerebellar abscess, with a resultant hydrocephalus.

The patient went to surgery immediately, with no residual neurological deficit after surgery.

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