INTRACRANIAL COMPLICATIONS

1. INRACRANIAL COMPLICATIONS OF
OTITIS MEDIA
DR.NEENA KARUNA KARAN
MMCH

2. COMPLICATIONS OF OTITIS MEDIA
INTRA TEMPORAL
• Mastoiditis
• Petrositis
• Facial paralysis
• Labyrinthitis
INTRA CRANIAL
• Extra dural abscess
• Subdural abscess
• Meningitis
• Otogenic brain abscess
• Lat. Sinus
thrombophlebitis
• Otitic hydrocephalus

3. OTOGENIC BRAIN ABSCESS
 In adults
Usually follows CSOM with cholesteatoma
 In children
As a result of acute otitis media

4. ROUTES OF INFECTION
• Direct extension of ME infection through tegmen
• Retrograde thrombophlebitis
Cerebral
abscess
• Direct extension through Trautmann’s triangle
• Retrograde thrombophlebitis
Cerebellar
abscess

6. TRAUTMANN’S
TRIANGLE

7. Bacteriology
AEROBIC
• Staphylococci
• S.pneumoniae
• S.haemolytics
• E.coli
• P.aeruginosa
ANAEROBIC
• Peptostreptococcus
• Bacteroid fragilis

8. PATHOLOGY
STAGE OF INVASION
• Head ache ,low grade fever
STAGE OF LOCALIZATION
• No symptoms
• Localize the pus by formation of capsule
STAGE OF ENLARGEMENT
• Abscess began to enlarge
• Zone of edema -aggravation of symptoms
STAGE OF TERMINATION
Ruptures into ventricle /sub arachnoid space
fatal meningitis

10. CLINICAL FEATURES
THOSE DUE TO RAISED INTRACRANIAL TENSION
 Headache-worse in the morning
 Nausea & vomiting
 Level of conciousness
lethargy drowsiness confusion stupor coma
 Papilloedema
 Slow pulse & subnormal temperature

11. LOCALIZING FEATURES
 Temporal lobe abscess
 Nominal aphasia
 Homonymous hemianopia: pressure on optic
radiation
 Contralateral motor paralysis:
upward spread- face arm leg
Inward spread - leg arm face
 Epileptic fits
 Pupillary changes & oculomotor palsy

12.  Cerebellar abscess
 Headache
 Spontaneous nystagmus
 Ipsilateral hypotonia & weakness
 Past pointing & intention tremor
 Dysdiadochokinesia

13. INVESTIGATIONS
 Skull X-rays
 CT scan
o site &size of the lesion
o reveals associated complications
 X -ray mastoids or CT scan of temporal
bone
 Lumbar puncture : CSF shows-
rise in pressure
protein content
WBC Count
polymorphs/lymphocytes

14. TREATMENT
MEDICAL
 High doses of antibiotics parenterally
o Mixed infections:
o chloramphenicol+ 3rd gen.cephalosporins
o Bacteroides fragilis : metronidazole
o Pseudomonas/proteus : aminoglycosides
 ICT--Dexamethasone 4 mg iv 6 hrly /
mannitol 20% in doses of .5g/kg body wt
 Discharge from ear-Suction clearence & topical ear drops

15. NEUROSURGICAL
Abscess can be approached in
following ways :
 Repeated aspiration through a
burr hole
 Excision of abscess
 Open incision of the abscess
&evacuation of pus

16. OTOLOGIC
 AOM
Resolve with antibiotics given for abscess
 COM
Radical mastoidectomy

17. LATERALSINUS THROMBOPHLEBITIS
SIGMOID SINUS
THROMBOSIS
It is an inflammation
of inner wall of lateral
venous sinus with
formation of an
intrasinus thrombus.

18. PATHOLOGY
1.Formation of perisinus abscess
2.Endophlebitis & mural thrombus formation
3.Obliteration of sinus lumen & intrasinus abscess
4.Extension of thrombus

22. BACTERIOLOGY
• S.haemolyticus
• Pneumococcus
• Staphylococcus
Acute
infections
• Bacillus proteus
• E.coli
• P.pyocyaneus
Chronic
infections

23. CLINICAL FEATURES
 Hectic picket fence type of fever with rigors

24.  Head ache
 Progressive anaemia
& emaciation
 Griesinger’s sign
- due to thrombosis
of mastoid emissary
vein

25.  Papilloedema
its presence depends
on obstruction to
venous return.
 Tobey –Ayre’s test
Record CSF pressure by
manometer

27.  Crowe -beck test
Pressure on jugular vein of healthy side
engorgement of retinal veins & supra orbital veins
 Tenderness along jugular vein

28. INVESTIGATIONS
 Blood smear : to rule out malaria
 Blood culture : to find out causative organisms
 CSF examination : shows rise in pressure
 X ray mastoid :
clouding of cells - acute mastoiditis
destruction of bone – cholesteatoma

29.  Imaging studies
 Culture & sensitivity of ear swab

30. COMPLICATIONS
 Septicaemia & pyaemic abscesses
 Meningitis & subdural abscess
 Cerebellar abscess
 Thrombosis of jugular bulb & jugular vein
 Cavernous sinus thrombosis
 Otitic hydrocephalus

31. TREATMENT
 IV antibacterial therapy:
should be continued at least for a week after the
operation
 Mastoidectomy & exposure of sinus:
complete cortical/modified radical
mastoidectomy
Sinus bony plate is removed to expose the dura
& drain the perisinus abscess

34.  Ligation of internal jugular vein
 Anticoagulant therapy:
used when thrombosis is extending to cavernous
sinus
 Supportive treatment:
Repeated blood transfusions

35. OTITIC HYDROCEPHALUS
 Characterised by raised intra cranial pressure with
normal CSF findings

36. MECHANISM
middle ear infection
lateral sinus thrombosis
Obstruction to thrombosis exends to
venous return sup.sagittal sinus
impede CSF absorbption
by arachanoid villi
raised intra cranial tension

37. CLINICAL FEATURES
Symptoms
 Severe head ache
 Diplopia
 Blurring of vision

38. Signs
 Papilloedema
 Nystagmus
 Lumbar puncture
CSF pr exceeds 300 mm H2O

39. TREATMENT
to reduce CSF pr …
achieved by
Acetazolamide
Corticosteroids
Repeated lumbar puncture
Placement of lumbar drain
Lumbo peritoneal shunt
 Middle ear infection
Antibiotic therapy
Mastoid exploration

40. LUMBOPERITONEAL SHUNT