Otogenic brain abscess due to complicated otitis media and mastoiditis

Case contributed by Dr Michael P Hartung

Presentation

Chronic right ear infection with new neurological deficits.

Patient Data

Age: 20 years
Gender: Female

Right middle ear and mastoid effusion. Right mastoid has loss of bone with thinning of the wall. Small focus of pneumocephalus just cranial to the sinus indicates erosion of the wall. 

Extradural enhancing collection along the posterior and lateral right cerebellum. Several smaller enhancing cerebellar collections are associated with right sigmoid and transverse sinus thrombosis. Midline shift and tonsillar herniation due to cerebellar edema/subdural collections with crowding of the brainstem. Diffuse effacement of the sulci with hydrocephalus due to 4th ventricular obstructions. 

Case Discussion

Uncommon but severe complication of otitis media resulting in subdural and cerebellar abscesses. This advanced presentation requires urgent intervention due to compression of the fourth ventricle resulting in hydrocephalus and cerebellar tonsillar herniation. 

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