Intracranial complication of CSOM for UG medical students - by M.vignesh zentronz G.T.M.C

1. - M . V I G N E S H
Z E N T R O N Z
G . T . M . C
Intracranial complications of
CSOM

2. Intracranial complications of CSOM:
Extradural Abscess,
Subdural Abscess,
Meningitis,
Otogenic brain abscess.

3. Extradural Abscess:
Collection of pus between bone and dura
Occurs in both acute and chronic infections

4. PATHOLOGY:
 Acute ostitis media –bone over dura destroyed by
hyperemic calcification
 Chroni ostitis media – destroyed by cholesteatoma
 The affected dura may be covered with granulations
or appear unhealthy and discoloured

5. Clinical features:
Persistant headache on the affected side,
Severe ear ache,
malaise,
Pulsatile ear discharge,
Headache will be disappear after the ear discharge,

6. Treatment:
Radical mastoidectomy:
Extradural abscess is evacuated by
removing overlying bone till the limits of healthy
dura is reached
Antibiotics:
Antibiotics should be given for 5 days

7. Subdural Abscess:
Collection pus between dura and arachnoid
Pathology:
Infection in ear
Erosion of bone & Thromboplebitis
dura
subdural dural Abscess
Pressure symptoms

8. Clinical features:
Meningeal irritation,
Fever (102 F ),
 Headache,
 Neck rigidity,
 Malaise,
Cortical venous thromboplebitis causes aphasia,
hemiplegia, hemianopia,
Rised intracranial tension causes ptosis & dilated
pupils and involment of other cranial nerves

9. Treatment:
In case of neurological emergency Lumbar puncture
should be done,
Craniotomy is done to drain the subdural empyema,
Intravenous antibiotics can be given to control
infection

10. Meningitis:
Inflamation of leptomeninges due to bacterial
invasion of CSF,
Most common intracranial complication of otitis
media,

11. Clinical features:
 Fever (102-104 f) with chills and rigors,
 Headache,
 Neck rigidity,
 Photophobia and mental irritability,
 Nausea and vomiting,
 Drowsiness,
 Cranial nerve palsies and hemiplegia,

12. Diagnosis:
CT or MRI helps to diagnosis,
CSF Finding:
It is turbid,
Cell count is raised upto 1000ml,
Protein level is raised,
Sugar level is reduced,
Chlorides are diminished,
Culture helps to identify the causative organism and
antibiotic sensitivity

13. Treatment:
Medicine:
Corticosteriods and antibiotics helps to reduce the
neurological and audiological complications
Surgery:
Meningitis in ASOM: myringotomy or cortical
mastoidectomy,
Meningitis with cholesteatoma
in CSOM: modified racial
mastoidectomy

14. Otogenic brain abscess:
In adults abscess follows chronic suppurative otitis
media with cholesteatoma,
In children, it results from acute otitis media

15. Pathology:
There are 4 stages:
Stage of invasion,
Stage of localization,
Stage of enlargement,
Stage of termination.

16. Stage of invasion:
Initial encephalitis,
Symptoms are slight,
May feel headache low-grade fever and drowsiness,
Stage of localization:
Latent abscess,
Immune system tries to localize the pus by forming
the capsule,
Last for several weeks.

17. Stage of enlargement:
Manifest abscess,
Abscess begins to enlarge,
A zone of abscess appears around the abscess,
Raised intracranial tention,
Distrubance in cerebellar and cerebral function.
Stage of termination:
Rupture of abscess,
Abscess in white matter ruptures into ventricles or
subarachnoid space resulting in fatal meningitis.

18. Clinical features:
Headache,
Nausea and vomiting,
Level of conciousness: lethargy progresses to
drowsiness, confusion, stupor and coma,
Papilloedema appears when raised intracranial
tension,
Slow pulse and subnormal temperature,

19. Temporal lobe abscess:
Nominal aphasia,
Homonymous hemianopia,
Contralateral motor paralysis,
Epileptic fits,
Pupillary changes and oculomotor palsy: Indicates
transtentorial herniation

20. Cerebellar abscess:
Spontaneous nystagmus,
Spontaneous nystagmus
Ipsilateral ataxia
Past-pointing and intention tremor: can be elicited
by finger nose test
Dysdiadochokinesia: Rapid pronation and
supination of the forearm shows slow and irregular
movements on the affected side

21. Treatment:
Medicine:
Chloramphenicol and third generation
cephalosporins are usually effective,
Bacteroides fragilis, an obligate anaerobe responds
to metronidazole,
gentamicin, may be required if infection suspected is
pseudomonas or proteus,
Raised intracranial tension can be treated by
dexamethasone, 4 mg i.v. 6 hourly or mannitol 20%
in doses of 0.5 g/kg body weight

22. Surgery:
It can be treated surgicaly by:
1.) repeated aspiration through a burr hole,
or
2.) excision of abscess,
or
3.) open incision of the abscess and evacuation of
pus