Otogenic cerebellar abscesses

Case contributed by Ibrahim Mohamed
Diagnosis certain

Presentation

Male patient presented to the emergency room with sudden decreased conscious level.

Patient Data

Age: 55 years
Gender: Male
mri

Multiple infra-tentorial cystic lesions elicited low signal in T1 and high signal in T2, with smooth ring enhancing walls as well as the adjacent leptomeningeal surface. The lesion is surrounded by perilesional vasogenic brain edema and is seen causing significant compression over the 4th ventricle with subsequent moderate supra-tentorial hydrocephalic changes, in addition to significant midline shift and contralateral tonsillar herniation.

DWI revealed restricted diffusion of the fluid contents with low ADC value (true restriction).

Abnormal signal was seen within the region of the right middle ear, associated with small enhancing lesions connected to the aforementioned abscesses.

Case Discussion

Male patient presented to the emergency room with sudden decreased conscious level. Upon questioning his relatives, they stated that he has been taking mediation for right ear infection for the past 2 months.

Urgent contrast enhanced MRI was done, followed by urgent surgical intervention which confirmed the presence of multiple cerebellar abscesses and removal of about 20ml of pus was done.

This case is a good example of a rare but fatal complication of chronic otitis media, causing meningoencephalitis and subsequent abscess formation. Urgent diagnosis and intervention is crucial, to prevent disabling/fatal complications.

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