The document discusses several potential intracranial complications that can arise from chronic suppurative otitis media (CSOM), including: 1. Extradural abscess - pus collects between the bone and dura, often caused by bone erosion or thrombophlebitis. 2. Subdural abscess - pus collects against the brain surface, causing symptoms and becoming loculated. 3. Meningitis - inflammation of the meninges and bacterial invasion of CSF, presenting with fever, headache, neck stiffness. 4. Otogenic brain abscess - develops in the temporal lobe or cerebellum, presenting with headaches, seizures, and focal neurological deficits depending on

1. INTRACRANIAL COMPL.- CSOM
• EXTRADURAL ABSCESS
• SUBDURAL ABSCESS
• MENINGITIS
• OTOGENIC BRAIN ABSCESS
• LATERAL SINUS THROMBOPHLEBITIS
• OTITIC HYDROCEPHALUS

2. EXTRADURAL ABSCESS
PATHOLOGY
• Coll. of pus b/w bone & dura-middle or post. Cranial
fossa
• Affected dura- covered i granulation & discoloured.
• a/c- bone over dura-destroyed by hyperaemic
decalcification.
• c/c-destroyed by cholesteatoma
• Spread
– destruc. Of bone
– venous thrombophlebitis- bone over dura remains
intact

3. • C/F
mostly asymp.- discovered CM or MRM
presence suspected when
persistent headache on side of otitis media
severe ear ache
pulsatile purulent ear d/s
disapp. Of headache- i flow of pus from ear
general malaise i low grade fever
• DIAGNOSIS
Contrast enhanced CT or MRI

4. • Rx
abscesss- evacuated by removing overlying bone till
healthy dura are reached.
Causative d/s- CM
broad spectrum antibiotics

5. SUBDURAL ABSCESS
• PATHOLOGY
Spread- erosion of bone & dura
or thrombophlebitic process- bone intact.
pus lie against surface of cerebral hemisphere
causing pr. Symp and pus get loculated.
•

6. C/F
MENINGEAL fever(102F or more)
IRRITATION Headache
malaise, drowsiness
neck rigidity
+ve kernig’s sign
THROMBOPHLEBITIS- aphasia, hemianopia, hemipleg
CORTICAL VEINS OF ia
CEREBRUM jacksonian type of epileptic fits
RAISED ICT III nerve- Papilloedema,
ptosis, dilated pupil

7. • DIAGNOSIS
CT scan or MRI
• Rx
Series of burr hole OR
Craniotomy
BSA
once infection subsides- CM
LP- cause herniation of cerebellar tonsils.

8. MENINGITIS
• Inflm. Of Leptomeninges.(piamater and arachnoid
)+ bact. Invasion of CSF in subarachnoid space.
• Most common intracranial complication
• 2nd most compl. Of OM.
• Infants & children- a/c- blood borne
adults-c/c - bone erosion or thrombophlebitis- asso
Extradural abs. or granulation tissue

9. C/f
Infection
Raised ICT
meningeal or cerebral irritation.
• Fever 102-104F+ chills & rigor
• Headache
• Neck rigidity
• Photophobia & mental irritability
• N, V(projectile)
• Drowsiness
• CN palsies & hemiplegia

10. EXMN
Tendon reflexes -exaggerated during initial stage,
later – sluggish or absent
Papilloedema – late stages

11. Diagnosis:
examination of CSF-culture and antibiotic sesitivity
lumbar puncture
• Turbid
• increased cell count-polymorphs.
• Protein level- increased
• reduced glucose levels (1.7-3 mmol/l )
• Chloride content - fall from 120 mmol/l to 80mmol/l.
CT or MRI

12. Rx
• Med
-systemic antibiotics-BSA
Corticosteroids
• Surgical
– a/c- CM
– c/c- MRM or RM

13. OTOGENIC BRAIN ABSCESS
• always develop in the temporal lobe or the cerebellum of the same
side of the infected ear. Temporal lobe abscess is twice as common as
cerebellar abscess.
• In children -25% of brain abscesses are otogenic – a/c
• In adults -50% of brain abscess are otogenic- c/c
TEMPORAL LOBE ABSCESS CEREBELLAR ABSCESS
Spread direct extension -eroded direct extension -Trautmann's
tegmen plate. triangle.
Retrograde Retrograde thrombophlebitis
thrombophlebitis
Asso- EDA EDA, perisinus abs, SST or
labtrinythitis

14. • PATHOLOGY

15. • C/F
RAISED ICT TEMPORAL LOBE ABSCESS CEREBELLAR ABSCESS
HEADACHE- generalised, NOMINAL APHASIA- pt fails HEADACHE-subocci. Asso i
worse in mrng. to tell name but can neck rigidity
demonstrate their use
N,V(proj.) SPONT. NYSTAGMUS- irreg,
HOMONYMOUS side of lesion
DROWSINESS, CONFUSION, HEMIANOPIA- visual field
STUPOR, COMA oppo to side of lesion is lost IPSILAT. HYPOTONIA &
Due to pr on optic radiations. WEAKNESS
PAPPILLOEDEMA- late, early in
cerebellar abscess CONTRALATERAL MOTOR IPSILAT. ATAXIA
PARALYSIS
Slow pulse Upward-face, arm leg PAST-POINTING & INTENTION
TREMOR- finger nose test
Subnl temp EPILEPTIC FITS
Uncinate gyrus-taste DYSDIADOKOKINESIA- rapid
hallucination, mvmt lips & pronation & supination of
tongue, generalised fits forearm show slow irreg mvmt
on affected side.
PUPILLARY CHANGES &
OCCULOMOTOR PALSY-
transtentorial herniation

16. • INVESTIGATION
SKULL X- RAY To see midline shift,
if pineal gland is calcified,
gas in abscess cavity
X-RAY MASTOID Evaluating asso ear d/s
CT SCAN & MRI To find the site & size of abscess cavity
Asso compl- EDA,SST,
LP danger because of the risk of coning.
CSF- rise in pr,
turbid
raised WBC- polymorphs 0r lymphocytes
raised protein level
nl glucose level

17. TREATMENT:
MEDICAL High dose iv antibiotics- Chloramphenicol+3rd gen
Cephalosporin
bacteroides- Metronidazole
pseudomonas , proteus- aminoglycoside- gentamicin
Raised ICT- Dexamethasone- 4mg iv 6th hrly or mannitol
20% - 0.5 g/kg body wt.
Ear discharge- suction clearence & topical ear drops
NEUROSURGICAL -drained by placement of burr holes,
-excision of the necrotic tissue along with the capsule.-
-Open incision of abscess and pus evacuation
-If abscess is treated by aspiration- repeat CT or MRI to
see if it diminish in size. Penicillin is instilled into
abscess after aspiration
OTOLOGIC a/c- may resolve i antibiotics

18. LATERAL SINUS THROMBOPHLEBITIS
FORMATION OF PERISINUS ABSCESS
ENDOPHLEBITIS AND MURAL THROMBUS FORMATION
OBLITERATION OF SINUS LUMEN AND INTRASINUS ABSCESS
EXTENSION OF THROMBUS- prox- sup sagittal sinus
dist- mastoid emissary vein, to jugular
bulb or jugular vein

19. C/F
HECTIC PICKET- FENCE TYPE OF FEVER I RIGOR Irregular fever-1 or > peaks/day, in b/w bouts
of fever- sense of well being.
profuse sweating follows fall of temp.
Due to septicaemia-release of septic emboli
HEADACHE Early- perisinus abscess
Late- raised ICT
ANAEMIA progressive
GRIESINGER’S SIGN Edema over post part of mastoid
Due to thrombosis of mastoid emissary veins
PAPILLOEDEMA Seen when rt sinus is thrombosed or when clot
extends to sup sagittal sinus
TOBEY- AYER TEST
CROWE- BECK TEST Pr on jugular vein of healthy side produce
engorgement of retinal veins & supraorbital
veins

21. INVESTIGATION
BLOOD SMEAR To rule out malaria
BLOOD CULTURE To find causative organism
Blood-taken at the time of chills
CSF EXMN Normal except for rise in pr,
To exclude meningitis
X-RAY MASTOID Asso ear d/s
CONTRAST ENHANCED CT SCAN Sinus thrombosis by typical delta sign or empty triangle
sign- rim show enhancement on post cranial fossa
central low density area on axial cut
MRI CONTRAST ENHANCED- Delta sign
MR venography- progression or resolution of thrombus
CULTURE & ANTIBIOTIC SENSITIVITY Ear swab

22. TREATMENT
IV ANTIBIOTICS BSA- continued at least for a week after operation
MASTOIDECTOMY CM-a/c or MRM-c/c
& EXPOSURE OF
SINUS Sinus bony plate is removed to expose dura- perisinus
abscess is drained
Intrasinus abscess of infected clots- dura is incised &
infected clot & abscess drained
IJV- LIGATION When above 2 therapy fail- to control embolic
phenomena & rigors
OR tenderness & swelling- JV spreading
ANTICOAGULANT If thrombus extend to cavernous sinus
THERAPY
SUPPORTIVE Anaemia- repeated blood transfusion
TREATMENT

23. OTITIC HYDROCEPHALUS
• It is a syndrome of raised intracranial pressure during or following
middle ear infection.
• also known as Pseudotumorcerebri.
• Pathogenesis:
– lateral sinus thrombosis -affects cerebral venous outflow,
– or the extension of the thrombus into the superior sagittal sinus impedes CSF
resorption by arachnoid villi

24. SYMPTOMS
C/F
headache Severe
diplopia Paralysis of VI CN
blurred vision Papilloedema or optic atrophy
SIGNS
papilloedema.
Nystagmus Due to raised ICT
LP Pr- >300mm of water (70-120mm water)
All other normal

25. TREATMENT
• ACETAZOLAMIDE
• CORTICOSTERIODS
• REPEATED LP OR PLACEMENT OF LUMBAR DRAIN
• LUMPOPERITONEAL SHUNT
• ASSO EAR INFECTION

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