Chronic middle ear disease eroding into cranial cavity - (otogenic) cerebellar abscess and venous sinus thrombosis
3 weeks of middle ear infection L > R. Now headache with vomiting and ataxia.
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Soft tissue opacity in the left middle ear cleft is associated with ossicular chain erosion (head of the malleus and body of the incus) with extension into the mastoid antrum via the additus. Scutum remains intact. Erosion of the posterior antral wall into the cranial cavity with filling defect indicative of thrombus in the left sigmoid sinus and internal jugular vein as well as a large peripherally enhancing mass indicative of abscess in the left cerebellar hemisphere. Marked compression to the IVth ventricle with lateral and IIIrd ventricular hydrocephalus.
The complications of suppurative middle ear disease are rare but can be devastating. They are often multiple as in this case with osteitis of the mastoid, thrombophlebitis of the sigmoid sinus thrombosis and brain abscess leading to obstructive hydrocephalus.