CNMC UG

1. OTOLOGIC INTRACRANIAL
COMPLICATION
SOMNATH SAHA

2. VARRIANTS
 MENINGITIS
 EXTRADURALABSCESS
 SUBDURAL ABSCESS
 SINNUS THROMBOPHELBITIS
 TEMPORAL LOBE ABSCESS
 CEREBELLAR ABSCESS
 OTITIC HYDROCEPHALOS

3. MODE OF SPREAD
 PREFORMED PATHWAYS-FRACTURE
OF TEMPORAL BONE,LABRYNTH,
UNUNITED CRANIAL SUTURES,
VASCULAR FORAMINA,& CONG.
DEHISCENCES
 DIRECT SPREAD-EROSION/OSTEITIS

4. LABRYNTH
 INF-POST FOSSA
 S.A. SPACE
 LOCALISED
ABSCESS IN IAM
 EXTRADURAL
ABSCESS NEAR
ELS

5. I.C.C
 M.E.C
 MENINGES
 ACROSS THE MENINGES
 INVASION OF BRAIN TISSUE

6. WHAT HAPPENED WHEN
MENINGES GET INVOLVED?
 PACHYMENINGITIS DURAL THICKENING &
ADHERENCE TO BONE
 GR. TISSUE FORMATION ON DURA &SUBDURAL
SPACE MAY REACT BY OBLITERATION
 FORMATION OF ED ABSCESS
 LARGE ED ABSCESS MAY PRESENT AS POTTS
PUFFY TUMOUR
 MAY DEVELOP SUBDURAL EMPYEMA

7. MENINGITIS
 MOST COMMON ICC
 SYMPTOM : FEVER,HEADACHE,
VOMITING,ALTERED SENSORIUM
 SIGN :NECK RIGIDITY, POSITIVE
KERNIGS&BRUDZINSKIS SIGN
 INV:C.T,FUNDUS&L.P
 TREATMENT:ANTIBIOTICS &
SURGERY

8. EPIDURAL ABSCESS
SIZE
 ED ABSCESS IN MC FOSSA
 EDA MEDIAL TO ARCUTE EMINENCE
 EDA IN POST. FOSSA
 POTTS PUFFY TUMOUR

9. EPIDURALABSCESS-contd.
 MAY BE SYMPTOMLESS
 HEADACHE
 SYMPTOM IN COMMUNICATING
ABSCESS
 SYMPTOM IN LARGE MCF LESSION
 EDA OVER PETROUS APEX
GRADENIGO SYNDROME
 POST.FOSSA EDA PERISINIOUS ABS.

10. DIAGONOSIS&TREATMENT
OF EDA
 MANY CASES ACCIDENTALLY
DISCOVERED DURING SURGERY
 ENHANCED C.T OR MRI
 TREATMENT SURGICAL DRAINAGE
&ANTIBIOTICS
 IN CASE OF PERISINIOUS ABSCESS
SIGMOID SINUS SHOULD BE
CHEAKED

11. SUDURAL EMPYEMA
 LOCATED BET. DURA &PIA-ARACHNOID
MEMBRANE
 MOST EMERGENT NS CONDITION
 SYMPTOM-SEVERE HEADACHE
&MARKED RISE OF TEMP.
 LEFT SIDE INF APHASIA& PROGRESSIVE
CONIRALATERAL HEMIPARESIS
 PARALYSIS OF CONJUGATE GAZE TO
CONTRALATERAL SIDE/ DEVIATION OF
EYE TOWARDS THE SIDE OF LESSION

12. SUDURAL EMPYEMA-CONT.
 JACKSONIAN SEIZURES
 MARKED NECK STIFFNESS
&PAPILLEDEMA IN POST. FOSSA LS
 IMAGAING STUDIES
CONFIRMATORY
 Tt: IMM. NS DRAINGE& ANTIBIOTICS

13. SIGMOID SINUS
THROMBOSIS
 PATHOLOGY
 SYMPTOM;FEVER,HADACRE&NECK
STIFFNESS
 SIGN:GRESSINGER SIGN ; LILLE _
CROW TEST;TOBEY –AYER TEST
 CT DELTA SIGN
 MR
 TREATMENT

14. BRAIN ABSCESS
MECHANISM OF BRAIN
TISSUE INVASION
 THROMBOPHELBITIS OF LAT.SINUS
 RETROGRADE EXTN. ALONG A
CEREBELLAR VESSEL
 CEREBELLAR THROMBOPHELBITIS
 CEREBELLAR ABSCESS(LST+CA)
 SPT+TLA MAY ALSO OCCUR

15. BRAIN TISSUE INVASION
 PERIVASCULAR
ROUTE THROUGH
VIRCHOW-ROBIN
SPACE
 THROMBOPHELBI
TIS OF
MENINGEAL VS.

16. STAGES OF ABSCESS
FORMATION
 CEREBRAL THROMBOPHELBITIS
 UNCONTROLLED INFECTION ENCEPHALITIS
&BRAIN OEDEMA
 FOCAL NECROSIS &LEQUFECETION
 ABSCESS FORMATION
 ENCAPSULATION

18. FORMATION OF
MULTILOBULAR ABSCESS
 ACUTE ABSCESS
 ENCPSULATION
 CHRONIC ABSCESS
 BREAKAGE OF
CAPSULE
 NEW ABSCESS
FORMATION&
ENPSULATOIN
 FORMATION OF M.L
ABSCESS

20. FATE OF ABSCESS
 CEREBRUM ABSCESS TENDS TO
PROGRESS TOWARDS LATERAL
VENTRICLE MAY RUPTURE
 OVERWHELMING INFECTION OF
VENTRICULAR SYS.&S.A SPACE
 RUPTURE NOT NECESSARILY FATAL
 CEREBELLAR ABSCESS MAY BURST
INTO FOURTH VENTRICLE

21. FATE OF ABSCESS-CONTD
 ABSCESS+OEDEMA
 S.O.L+HYDROCEPHALOS
 COMPRESSION OF LAT. VENTRICLE
 UNCUS DISPLACEMENT
 MID BRAIN COMPRESSION
 OBS. OF CSF FLOW
 FURTHER IN VENTRICULAR PR.
 DEATH DUE TO S,T HYDROCEPHALOS

23. FATE OF UNTREATED
CEREBELLAR ABSCESS
 CEREBELLAR ABSCESS
 MAY DISPLACE FLOCCULAS
 IN FORAMEN MAGNUM
 PODUCES CORKING
 CONSEQUENT FAILURE OF C.V.
&RESPIRATORY CENTRES

24. SYMPTOM &SIGN OF
BRAIN ABSCESS
 THE STAGE OF INVASION
 THE STAGE OF ESTABLISHED DS.
 TERMINAL STAGE

25. STAGE OF INVASION
 EARACHE
 HEADACHE
 NAUSEA &VOMITING
 DROWSINESS
 CHANGE OF TEMP.&PULSE RATE

26. STAGE OF ESTABLISHED DS.
 INCREASE HEADACHE INTENSITY
 PROJECTILE VOMITING
 DROWSINESS MAY PROGRSS TO
COMA
 GIDDINESS
 EPILEPTIC FITS
 APHASIA

27. STAGE OF ESTABLISHED DS.
SIGNS
 NECK RIGIDITY
 PAPILLOEDEMA
 HEMIPLEGIA
 NYSTAGMUS

28. TERMINAL STAGE
 LOW TEMP.&SLOWING PULSE RATE
 CHEYNE-STOKES BREATHING IN A
DEEPLY COMATOSED PT.
 DILATED FIXED PUPILS
 TEMP. &P.R MAY SUDDENLY RISE
BEFORE DEATH

29. MANAGEMENT
 START Tt WITH CL. SUSPICION
 OBTAIN C.T SCAN
 CONSULT NEUROSURGEON
 CONCOMITANT DRAINGE OF BRAIN
ABSCESS &MASTOIDECTOMY
OFFERS BEST PROGNOSIS