이성 뇌농양의 임상양상과 치료

Abstract

Background and objetives: Otogenic brain abscess is the second most common intracranial complication of middle ear infections next to meningitis. With advanced radiologic technique and early antibiotic treatment, the incidence has been reduced. It is, however, one of the most significant life-threatening complications of otologic disease. Its mortality rates have been reported as up to 10%. The purpose of this study was to review the clinical presentations and to investigate prognostic factors of otogenic brain abscess. Materials and method: The study group consisted of 7 patients whose otogenic brain abscesses were diagnosed and treated, between January 1994 and July 2004, retrospectively reviewed in Departments of Otolaryngology and Head & Neck Surgery, College of Medicine, Dong-A university. There were 6 males and 1 female, and their ages ranged from 12 to 66 years, mean 41.9 ±22.2 years. The diagnosis and postoperative follow-up were based on the computed tomography and magnetic resonance imaging. Results: The most common presenting symptom was headache with otorrhea. Other generalized symptoms and signs included otalgia, fever and symptoms of increased intracranial pressure, 6 patients, even had altered mental status. Primary brain computed tomography could diagnose brain abscess in 6 patients, another 1 patient could be diagnosed by additional magnetic resonance imaging 5 days later. One of these was associated with acute otitis media, two with mastoidectomy, and four with chronic otitis media with cholesteatoma. There were eroded tegmens by cholesteatoma in all cases, but direct invasion of cholesteatoma into brain parenchyma was not found in any case. Aggressive medical or surgical management were performed in all cases. In addition to mastoidectomy, neurosurgical operation was performed in 6 patients. Six patients had no neurological sequelae, but one case, diagnosis was too late, had permanent hemiparesis. Conclusion: Early diagnosis was the most important prognostic factor of otogenic brain abscess. Magnetic resonance imaging should be more preferred than brain computed tomography for early diagnosis of brain abscess. (J Clinical Otolaryngol 2005;16:240–246)