Danish medical journal · 2014
Diagnostic challenges in otogenic brain abscesses.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Lildal Tina Kissow, Korsholm Jakob, Ovesen Therese
Аннотация
INTRODUCTION: Otogenic brain abscess (OBA) is a rare complication to otitis media, but one with a potentially devastating outcome. Early diagnosis of OBA is crucial for successful treatment. The objective of this study was to determine the incidence of OBA in a Danish population and to describe its clinical manifestation, management and outcome.
MATERIAL AND METHODS: A total of 93 patients were retrospectively enrolled by diagnosis codes for brain abscess from 1999 to 2010. Records were reviewed to register age, symptoms, clinical findings, co-morbidity, imaging, microbiology and treatment.
RESULTS: Seven were found to have had an otogenic focus of infection. The incidence of OBA was 1/million, and the mean age was 43 years, ranging from ten to 81 years. Five patients had acute otitis media and two had infectious cholesteatoma. Four had previously suffered a head trauma. The young patients presented with symptoms indicative of meningitis and the elderly patients with symptoms resembling a stroke. None of the patients were treated with antibiotics before admission to hospital. No mortalities occurred, but three had sequelae in the form of hearing loss and/or neurological impairment.
CONCLUSION: The OBAs manifested with symptoms mimicking meningitis in young patients and stroke in elderly patients. Absence of fever does not rule out OBA; and regardless of any present ear symptoms, an ear, nose and throat examination should be performed without delay to locate the focus of infection and to facilitate targeted treatment.
FUNDING: not relevant.
TRIAL REGISTRATION: not relevant.
MATERIAL AND METHODS: A total of 93 patients were retrospectively enrolled by diagnosis codes for brain abscess from 1999 to 2010. Records were reviewed to register age, symptoms, clinical findings, co-morbidity, imaging, microbiology and treatment.
RESULTS: Seven were found to have had an otogenic focus of infection. The incidence of OBA was 1/million, and the mean age was 43 years, ranging from ten to 81 years. Five patients had acute otitis media and two had infectious cholesteatoma. Four had previously suffered a head trauma. The young patients presented with symptoms indicative of meningitis and the elderly patients with symptoms resembling a stroke. None of the patients were treated with antibiotics before admission to hospital. No mortalities occurred, but three had sequelae in the form of hearing loss and/or neurological impairment.
CONCLUSION: The OBAs manifested with symptoms mimicking meningitis in young patients and stroke in elderly patients. Absence of fever does not rule out OBA; and regardless of any present ear symptoms, an ear, nose and throat examination should be performed without delay to locate the focus of infection and to facilitate targeted treatment.
FUNDING: not relevant.
TRIAL REGISTRATION: not relevant.