Development Of Intracranial Complications Research Articles

Latent mastoiditis (literature review)

Introduction. Mastoiditis is an extracranial complication of acute or chronic purulent otitis media, leading to periostitis or osteitis of the mastoid process, accompanied by obvious symptoms and requiring urgent surgical treatment. Latent mastoiditis is defined as a stage of local inflammation due to acute otitis media, without an obvious clinical picture of progressive destruction of the bone cells of the mastoid process. Recently, there has been a trend towards an increase in indolent forms of mastoiditis. The use of systemic antibiotic therapy for the treatment of acute otitis media complicates timely diagnosis and contributes to the chronicity of inflammation in the structures of the temporal bone. Making a diagnosis of latent mastoiditis requires vigilance from outpatient clinicians and the use of objective imaging methods due to the risk of developing intracranial complications.Aim. Conduct a review of literature sources to determine diagnostic criteria for the formation of latent mastoiditis in outpatient patients.Materials and methods. A search was carried out for articles from public databases using the query: “latent mastoiditis”, including data from literary sources whose authors made a significant contribution to the development of otorhinolaryngology. Summary data of the literature review, including both original studies and descriptions of clinical cases, identifying the main causes of the formation of latent mastoiditis and its clinical symptoms.Results and discussion. Local inflammation of the mastoid process, due to acute otitis media, has a progressive course of chronic sluggish inflammation of the bone structures of the temporal bone. Diagnosis of latent mastoiditis causes difficulties for practical healthcare doctors due to subtle clinical manifestations, and therefore it is necessary to determine the indications for referral to computed tomography.Conclusion. The medical and social significance of latent mastoiditis is that it has an unfavorable not only functional, but sometimes life prognosis, as it can cause the development of intracranial complications.

БАЗАЛЬНАЯ ЛИКВОРЕЯ: ВЗГЛЯД ОТОРИНОЛАРИНГОЛОГА

Disruption of the integrity of the liquor space (regardless of the cause) and liquorrhea as a consequence have a high risk of pyo-inflammatory intracranial complications in the patient: the incidence of nasal liquorrhea intracranial complications reaches 25 - 35%. The risk at liquorrhea lasting more than 3 months increases up to 60%, and the development of intracranial complications in a patient in 78.8% of cases was observed more than once. The mortality rate from intracranial complications against the background of basal liquorrhea can be up to 50%. At the same time the incidence of basal liquorrhea, including delayed (a few months or years after injury) is increasing as well as the prevalence of injuries with damage to the skull base including iatrogenic kind is increasing too. Therefore, early diagnosis of liquorrhea is important. An otorhinolaryngologist in his practice may encounter any type of basal liquorrhea: nasal liquorrhea, otoliquorrhea and even orbital liquorrhea. These article based on a literature review and provid recommendations for the primary diagnosis of by head-neck specialists including otorhinolaryngologists.

Otogenic meningitis: A comparison of diagnostic performance of surgery and radiology

Development of intracranial complications from middle ear infections might be difficult to diagnose. We compared radiological and surgical findings of 26 patients affected by Otogenic Meningitis. Results of our analysis showed that surgery is more reliable than imaging in revealing bone defects. Therefore, suggest that surgery be performed for diagnosis and eventual management of all cases of suspected otogenic meningitis. Keywords: Computed Tomography, Magnetic Resonance Imaging, Middle Ear Infection, Otogenic Meningitis, Surgery.

Chronic Otitis Media with Granulation Is a Poor Prognostic Factor for Hearing Improvement and Development of Intracranial Complications

Different types of chronic otitis media are distinguished based on the observed lesions in the middle ear mucous. Hearing improvement is a measurable effect of the surgical treatment of patients with chronic otitis media. Chronic cholesteatoma otitis media and chronic otitis media with inflammatory granulation have a tendency to damage the bone tissue, leading to the development of intratemporal and intracranial complications. A prospective analysis of patients who underwent surgery for the first time due to chronic otitis media from 2009 to 2012 was performed. Patients were divided into groups according to the abnormalities of the middle ear mucous observed during otosurgery. Special attention was given to patients diagnosed with chronic otitis media with inflammatory granulation and chronic cholesteatoma otitis media, which are characterized by a tendency to damage the bone tissue. A total of 293 individuals met the criteria for inclusion in the study. The analysis showed that chronic otitis media with inflammatory granulation had an unfavorable effect on hearing improvement prognosticated postoperatively. Defects in the middle cranial fossa were observed to occur five times more often than defects in the posterior cranial fossa. These defects were usually observed with granulation tissue and rarely with the concurrence of cholesteatoma and granulation tissue. The presence of granulation tissue is an unfavorable prognostic factor for improvement in air and bone conduction. The probability of exposing the dura mater of the brain is higher in cases with granulation tissue than in cases with cholesteatoma.

Management of professional and specialized medical treatment in gunshot wounds of calvaria soft tissues

Research objective. To analyze aspects of gunshot wounds of head soft tissues, their combination to brain injury and on this basis to develop tactics and the principles of assistance at different stages of medical care in compliance of the military medical doctrine. Materials and methods. On the basis analysis of 1214 combat injuries of neurosurgical profile gunshot wounds were in 434 (35.6%). Wounds of calvaria head soft tissues are diagnosed at 241 (55.4%), in 193 (44.6%) there were nonpenetrating and penetrating wounds with injury of brain. From 241 wounded 141 (58.5%) have finished treatment in the military medical hospital (MMH) (the second level of medical care) and in 100 (41.5%) wounded who had concussion, contusion of the brain and/or getting traumatic brain injury (TBI) were treated in neurosurgical departments. Results and Conclusions. It is revealed that in 141 (58.5%) gunshot wounds of head soft tissues are not followed with brain injury. These wounded are in group of the low risk development of intracranial complications (RDIC) and have finished treatment at the second level of medical care in the MMH. In 100 (41.5%) of wounded soft tissues were followed by symptoms of brain injury (concussion, contusion, hemorrhage). These patients had average and high RDIC, and have been evacuated on the 3rd level of medical care and have finished treatment in specialized neurosurgical departments (the 3 and 4 levels). Gunshot wounds of head soft tissues without neurologic symptomatology can be treated at stage of the qualified medical care - the 2nd level - in field hospitals. Gunshot wounds of head soft tissues (41.5%) are followed often by traumatizing brain with average and high risk development of intracranial complications and this group of patients is evacuated on the third level of medical care in specialized neurosurgical departments.

MANAGEMENT AND SURGICAL OUTCOMES IN PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA

Background: Reconstruction of the ossicular chain is performed in 70-90% of tympanoplastic interventions. A cholesteatoma in chronic suppurative otitis media is diagnosed in 24-63% cases, irrespective of localization of the eardrum perforation. Persistently good outcomes after radical mastoidectomy is obtained only in 65 to 66% of patients, and the proportion of unsatisfactory results remains to be rather high (10 to 15%). Aim: To analyze the effectiveness of surgical treatment of patients with chronic suppurative otitis media, operated in a single clinical center from 2014 to 2016. Materials and methods: A total of 212 patients (233 ears) with chronic suppurative otitis media patients, who underwent surgery, were included in this study. The effectiveness of surgical interventions were assessed as short-term (up to 3 months post-operatively) and long-term (6 to 12 months) anatomical and functional outcomes. The anatomical results were considered satisfactory if there was a well-formed mobile neotympanic membrane, air tympanic cavity and dry postoperative cavity. Pure tone audiograms were analyzed to evaluate the functional results. Results: Satisfactory anatomical results were obtained in 93.5% of patients with the safe type suppurative otitis, 88.9% of patients with the unsafe type and 91.2% of patients after a revision surgery. Displacement of total ossicular prosthe-ses was the main cause of poor functional results. The most common causes of unsatisfactory anatomical results were perforation (14 cases), cholesteatoma recurrence (2 cases) and lateralization of the neotympanic membrane (2 cases). Discussion and conclusion: Formation of a reliable sound conducting system with ossicular prostheses allows for persistent improvement of hearing. Various surgical techniques, such as extended posterior tympanotomy, endoscopic assistance, provide a good effect with the removal of non-aggressive cholesteatoma while preserving the bone structures, which are not involved in the disease. A complete removal of an advanced aggressive cholesteatoma with the opening of the temporal bone cell system ensures good functional and anatomical outcomes, makes it possible to prevent the spread of the pathological process and development of intracranial complications.

The midline nasal lesion

This 2-year-old boy presented to the otolarynology department with a discharging midline nasal lesion. The lesion, present since birth, had occasionally discharged some pus-like fluid. It was usually treated with...

Acute Isolated Sphenoid Sinusitis

Introduction: Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis. It is frequently misdiagnosed because of its vague symptoms and the paucity of clinical findings. We report 2 cases of isolated acute isolated sphenoid sinusitis with unusual presentations. Clinical Picture: Both patients presented with acute headache, eye pain and fever, and were provisionally diagnosed as meningitis. In 1 case, the symptoms were on the contralateral side of the sphenoid infection. Intracranial complications were also present. Treatment: Treatment included intravenous antibiotics and endoscopic sphenoidotomy. Outcome: Both patients recovered with no residual neurological disability. Conclusion: Acute sphenoiditis usually presents with subtle symptoms and elusive physical findings and hence a high index of suspicion is necessary. Complications may arise due to the close proximity of important structures to the sphenoid sinus. Uncomplicated cases can resolve with optimal antibiotic therapy if diagnosed and treated early. Persistence or progression of disease with development of intracranial complications are indications for immediate surgical drainage.

Protective role of NF-κB1 (p50) in experimental pneumococcal meningitis

Nuclear factor-kappaB (NF-κB) is a critical regulator of many genes involved in the pathogenesis of bacterial meningitis. Recently, activation of NF-κB was shown to be a key event in the inflammatory host response and the development of intracranial complications during experimental pneumococcal meningitis. Since the p50 subunit of NF-κB lacks a transactivation domain and can therefore act as a transcriptional repressor, we investigated whether NF-κB1 (p50) exerts anti-inflammatory effects in pneumococcal meningitis. p50-deficient mice had higher cerebellar pneumococcal titers (10.06±0.47 vs. 8.51±1.06 log colony-forming units [cfu]/cerebellum), cerebrospinal fluid (CSF) leukocyte counts (11,475±2340 vs. 8444±1405 cells/μl) and brain concentrations of interleukin-1β (125.9±50.3 vs. 58.5±52.2 pg/mg protein) than their wild-type littermates. With ceftriaxone therapy, none of the wild-type mice but 43% of the p50-deficient animals died. In conclusion, lack of NF-κB1 (p50) was associated with impaired bacterial clearing, enhanced inflammatory host response and increased mortality during pneumococcal meningitis.

Oxidative stress in bacterial meningitis.

Fifty years after the advent of antibiotics for clinical use, the rates of morbidity and mortality associated with bacterial meningitis remain high. The unfavourable clinical outcome is often due to intracranial complications including cerebrovascular insults, raised intracranial pressure, hydrocephalus, and brain edema. Reactive oxygen species (ROS) are known effector molecules in the antimicrobial armature of polymorphonuclear and mononuclear phagocytes. However, over the last decade, there has been a substantial body of work implicating a central role of ROS in the development of intracranial complications and brain damage in bacterial meningitis. Recently, it also became evident that reactive nitrogen species (RNS), especially nitric oxide, are important mediators of meningitis-associated pathophysiological changes, at least during the early phase of the disease. There is now substantial evidence that much of the oxidative injury associated by simultaneous production of superoxide and nitric oxide is mediated by the strong oxidant peroxynitrite. ROS and peroxynitrite can be cytotoxic via a number of independent mechanisms. Their cytotoxic effects include initiation of lipid peroxidation and induction of DNA single strand breakage. Damaged DNA activates poly(ADP-ribose) polymerase (PARP). Recent experimental data propose a role of lipid peroxidation and PARP activation in the development of meningitis-associated intracranial complications and brain injury. Agents which interfere with the production of ROS and peroxynitrite, as well as with PARP activation and lipid peroxidation may represent novel, therapeutic strategies to limit meningitis-associated brain damage, and, thus, to improve the outcome of this serious disease.

Frontal Sinusitis with Chronic Epidural Abcess: A Case Presentation

The incidence of intracranial complications from acute frontal sinusitis has decreased with improved antimicrobial and surgical therapy. However, the physician must maintain a keen awareness and thoroughly investigate any possible signs of intracranial spread. This article discusses a case in which a chronic epidural abscess developed after inadequate therapy was rendered. It also reviews the presentation of and the factors leading to the development of intracranial complications. The treatment required is to eradicate the disease present and prevent future sinusitis.

Cerebrovascular accidents occuring as a complication of cardiac catheterization: a report of two cases.

Cardiac catheterization i s an accepted diagnostic technique with a mortality of less than 0.5% 1 and a correspondingly minor postoperative morbidity. Frequently this procedure is performed on older children and adults on an outpatient basis with only meperidine (Demerol) analgesia and local procaine infiltration anesthesia. One of the well-known potential hazards of congenital heart disease, particularly cyanotic congenital heart disease with secondary polycythemia, is the development of intracranial complications, either brain abscess 2 or spontaneous cerebral arterial thrombosis. 3 Cerebral artery thrombosis is most likely to occur during periods of dehydration or when the hematocrit is so high that the viscosity of the blood is increased appreciably. 4 The occurrence of this complication during the procedure of cardiac catheterization has not been reported. Within a period of two months, two patients, one with severe cyanotic congenital heart disease and another with an acyanotic congenital heart lesion, developed manifestations in the immediate posteatheterization period