Complications of Otitis Media: Mastoiditis and an Intracranial Abscess Presenting as Behavioral Changes.

An intracranial abscess is a rare but life-threatening complication of otitis media (OM) and mastoiditis that requires rapid diagnosis and intervention. We present the case of a 43-year-old woman who presented with acute altered mental status and aggressive behavior following recent treatment for OM. Physical examination revealed a perforated, purulent right tympanic membrane, and neuroimaging confirmed bilateral mastoiditis and a right temporal lobe brain abscess with midline shift. Following treatment with broad-spectrum intravenous antibiotics, the patient underwent a successful craniotomy for abscess evacuation, a mastoidectomy, and tympanostomy tube placement. Postoperatively, her behavioral and neurological symptoms fully resolved, and she was discharged to complete a prolonged course of antimicrobial therapy. This case underscores the importance of maintaining a high index of suspicion for otogenic intracranial complications in patients presenting with acute behavioral changes, emphasizing that early, multidisciplinary surgical and medical management is essential to optimize patient outcomes.