Extracranial Complications Research Articles

Complications of Chronic Suppurative Otitis Media

OBJECTIVEThe aim of the study was to find the complications of chronic suppurative otitis media.MATERIAL AND METHODSThe study was descriptive study conducted from 1st January 2008 to 31 December 2010 (3 years duration) at ENT department Khyber Teaching Hospital Peshawar. Total 250 patients of all age having complications due to chronic suppurative otitis media enrolled from admitted patients in ENT department Khyber Teaching Hospital Peshawar were included in the study, using convenience (non-probability) sampling.RESULTSIn total of 250 patients, all (100%) were having history of discharging ear, decreased hearing 250 (100%), earache in 75 (30%), fever in 31(12.4%), headache in 28 (11.2%), nausea and vomiting in 23 (9.2%) patients. The extracranial complications were found in 204/250 (81.6%) patients with mastoiditis being the most common in 155/204 (75.98%) patients followed by sensory reural hearing loss, post auricular abscess, facial paralysis, petrositis, labynthitis, Bezold’s abscess and cetili’s abscess in 7.84%, 6.37%, 5.88%, 1.7%, 0.98%, 0.98% and 0.49% patients respectively. While the intracranial complications were found in 46/250 (18.4%) patients with meningitis being the most common in 28/46 (60.9%) followed by brain abscess in 26%, lateral sinus thrombosis in 8.7% and otitic hydrocephalus in 4.4% patients.CONCLUSIONEarly detection and treatment of complications as a result of chronic suppurative otitis is vital to prevent morbidity and mortality.

Frequency of Extracranial Complications of Chronic Suppurative Otitis Media

Objectives: To see the way of presentation of extracranial complication, relationship between socio-economic conditions and extracranial complication of chronic suppuration otitis media.Methods: This is a cross-sectional study carried out in Department of Otolaryngology Head and Neck Surgery, Sir Salimullah Medical College & Mitford Hospital and Dhaka Medical College Hospital from 1st July 2009 to 30th June 2010. The diagnosis was made by detailed history, clinical examination & investigation. Analyzed data was presented by various tables.Results: In this study male (59%), lower class people (57%), age 11-20 years, rural (66%) and less educated patients were more affected. Having bath in the ponds and rivers suffers more. Clinical presentation of CSOM with complications were aural discharge (100%), hearing impairment (94%), post auricular swelling (15%), pain in the ear (21%), postauricular discharge (27%) and mass in the EAC (12%). Here found aural discharge mostly malodorous and scanty, attic perforation and cholesteatoma. Post auricular abscess most common (47%) extracranial complication and labyrinthitis was the lowest (3%). Atticoantral variety was more common (89%) than that of tubotympanic disease (11%).Conclusion: From the review of the series we found the frequency & types of extracranial complications arising from CSOM and known the current epidemiological data. It can produce awareness among all level of medical practitioners and enhance prompt diagnosis and treatment.J Bangladesh Coll Phys Surg 2016; 34(1): 3-8

Surgical outcome of the shunt: 15-year experience in a single institution.

Surgical outcome after shunt insertion in pediatric hydrocephalus can vary greatly. Although first shunt survival rates and complications have been studied by several teams, much less is known about survival and complications of subsequent systems. The goals of this study were to evaluate the surgical outcome in a series of pediatric patients followed for a long time and establish the differences between first and subsequent extracranial shunt survival and complications. We undertook a retrospective study in pediatric patients treated with ventriculoperitoneal shunts between 2000 and 2015 at our institution. Surgical outcome was assessed, and different shunt survival curves were studied with Kaplan-Meier. Complications related to each shunt failure were examined and compared. A total of 166 patients underwent 425 procedures, with a mean follow-up period of 93months. The median number of shunt revision surgeries was 2. Shunt survival rates were better with the first shunt compared to those with the subsequent shunts. The main complication necessitating system revision surgery was overdrainage, the frequency of proximal and distal dysfunctions was similar in all the shunt failures, and isolated ventricle and infection were more frequent in younger patients. Shunt-related infections accounted for 7% of the procedures, and the shunt independence rate was 10%. The frequency of complications related to shunt failure in pediatric patients changes during follow-up. A strict protocol of overdrainage detection and active treatment could explain the need for repeat surgeries and the progressively shorter shunt survival time in our series.

Complications in Aneurysmal Subarachnoid Hemorrhage Patients With and Without Subdural Electrode Strip for Electrocorticography.

Patients with aneurysmal subarachnoid hemorrhage (aSAH) frequently develop secondary noninfectious and infectious complications with an important impact on clinical course and outcome. In this study, we report on the rate of typical extracranial and intracranial complications in 30 prospectively enrolled patients with severe aSAH who received a linear subdural recording strip for continuous electrocorticography to detect ictal epileptiform events and spreading depolarizations. The group was compared with 30 retrospectively included patients with aSAH who had not received a subdural recording strip, but were treated during the same period. The control group was matched according to an aSAH grading system, sex, and establishment of external ventricular drainage, but could not be matched according to aneurysm treatment and focal brain lesions such as initial intracerebral hemorrhages. No evidence was found that procedures of the electrocorticography study led to clinically relevant complications. In particular, the subdural strip did not lead to local damage of brain tissue or any increased rate of meningitis/ventriculitis. The median score on the modified Rankin Scale on day 15 was the same in both groups. Minor differences between both groups are explained by the limitations in the study design. Our study suggests that neuromonitoring with a subdural recording strip for up to 15 days can be safely performed in patients with aSAH.

Contemporary clinical features of Cholesteatoma

Chronic Otitis media with Cholesteatoma is a destructive lesion of middle ear and mastoid region. In a series of 122 patients with established diagnosis of atticoantral disease, clinical characteristics of consecutive 74 patients with cholesteatoma otitis media were compared with 48 patients with chronic otitis media without cholesteatoma (Controls).The patients answered a questionnaire, preoperative and perioperative clinical observations were recorded. There were no specific presenting symptoms or clinical signs that could distinguished the cholesteatoma patients. However, these patients had a significantly higher incidence (32%) of previous middle ear surgery than the control patients (18%). Aural bleeding was reported in higher number in controlled cases (8.5%) as compare to cholesteatoma cases (1.3%). Pars flaccida perforation was noted in 94 % (80% isolated) in cholesteatoma patients. Extracranial complications e.g. mastoid abscess, postaural fistula, mastoiditis and otitis externa was note in 6.7% and 4% respectively in cholesteatoma and control group. The percentage of labyrinthitis and facial nerve affection was 11% and 4.1% in cholesteatoma cases respectively against 6% and 2% in control group. The cholesteatoma was not evident until the time of surgical exploration in as many as 28% of cases. Therefore surgical exploration appears to be the reliable and safest way to identify cholesteatoma.

Abstract 145: Differences in Presenting Symptoms of Fibromuscular Dysplasia Patients With Family History of Fibromuscular Dysplasia, Arterial Aneurysm, Dissection, or Sudden Death: A Report from the United States Registry for Fibromuscular Dysplasia

Introduction: Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disorder which may lead to stenosis, tortuosity, dissection, or aneurysm in any arterial bed. Some affected patients have a family history of FMD, arterial aneurysm (AA), arterial dissection (AD) or sudden death (SD), supporting a genetic predisposition. The clinical characteristics of this patient population have not been described. We hypothesized that patients with a family history of FMD, AA, AD, or SD would present differently than those without. Methods: By July 2014, of 880 patients enrolled in the United States Registry for FMD, 295 had a family history of FMD, AA, AD, or SD. These patients were compared to those without family history, analyzing demographics, symptoms at time of diagnosis, and vascular bed involvement. Student’s t-tests and Fisher’s exact tests were used to analyze continuous and categorical variables, respectively. Results: Patients with a family history of FMD, AA, AD, or SD were younger at diagnosis and more likely to experience CNS symptoms (headache, tinnitus, neck pain), post-prandial abdominal pain, as well as stroke and TIA at time of diagnosis. They also exhibited a trend toward more frequent carotid dissection (Table 1). Conclusions: Patients with a family history of FMD, arterial aneurysm (AA), dissection (AD), or sudden death (SD) more commonly had extracranial arterial bed complications, and experienced symptoms related to this vascular territory at time of diagnosis. These results suggest that FMD may present differently in those with this family history.

A case series of complicated infective otitis media requiring surgery in adults.

With the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognise otitis media and treat its complications early. Herein, we present our institution's experience with patients who required emergency surgical intervention for complications of otitis media. Data on patients who underwent emergency surgery for complications of otitis media from 2004 to 2011 was retrieved from the archives of the Department of Otolaryngology, Changi General Hospital, Singapore. A total of 12 patients (10 male, two female) underwent emergency surgery for complications of otitis media. The median age of the patients was 25 years. Otalgia, otorrhoea, headache and fever were the main presenting symptoms. Extracranial complications were observed in 11 patients, and six patients had associated intracranial complications. The primary otologic disease was acute otitis media in six patients, chronic otitis media without cholesteatoma in three patients and chronic otitis media with cholesteatoma in three patients. Mastoidectomy and drainage of abscess through the mastoid, with insertion of grommet tube, was the main surgical approach. Two patients required craniotomy. The mean length of hospital stay was 16.2 days and the mean follow-up period was 16.3 months. Five patients had residual conductive hearing loss; two patients with facial palsy had full recovery. Otitis media can still result in serious complications in the post-antibiotic era. Patients with otitis media should be monitored, and prompt surgical intervention should be performed when necessary to attain good outcomes.

Acute care of patients with bacterial meningitis

Bacterial meningitis is a life-threatening emergency that is still associated with high mortality and poor outcome. The purpose of this article is to provide a review of clinical presentation, diagnostic procedure, therapy, and prognosis in bacterial meningitis. Prognostic factors which could be influenced positively are identified and a focused procedure in the emergency setting and for the treatment of complications are provided. This work is based on a literature search (PubMed, guidelines) and personal experience (standard operating procedures, SOP). Despite improved health care, bacterial meningitis is still associated with high mortality and poor neurological outcome, which has remained largely unaltered during recent decades. Diagnosis and, more importantly, effective therapy of bacterial meningitis are often delayed, having an immediate negative influence on clinical outcome. Neurological and nonneurological complications often necessitate intensive care and may occur rapidly or in the further course of the disease. Immediate initiation of effective therapy is crucial to positively influence mortality and neurological outcome. Antibiotics should be administered within 30min after admission. To achieve this, a focused and well-organized procedure in the emergency setting is necessary. Because of intra- and extracranial complications, patients need to be treated on intensive care units including neurological expertise and interdisciplinary support.

Efficacy and Safety of Cilostazol Therapy in Ischemic Stroke: A Meta-analysis

Antiplatelet therapy is recommended for patients who have experienced ischemic stroke. We performed a meta-analysis to compare the efficacy and safety of cilostazol with other antiplatelet therapies in patients with ischemic stroke. PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English from May 1999 to May 2013. Clinical outcomes were compared by pooled and meta-regression analyses. Nine studies involving 6328 patients satisfied our inclusion criteria. Stroke recurrence (including hemorrhagic and ischemic) with cilostazol use was 5.3% (157) versus 8.3% (248) in control group (risk ratio .63 [.52-.76], 95% confidence interval [CI]). Poststroke intracranial hemorrhage was .5% (16) with cilostazol versus 1.6% (46) in control group (risk ratio .36 [.21-.63], 95% CI). Poststroke extracranial bleeding complications occurred in 2.4% (66) of the patients taking cilostazol versus 3.9% (108) in control group (risk ratio .62 [.46-.83], 95% CI). No significant difference in cerebrovascular events (nonfatal stroke, intracranial hemorrhage, and transient ischemic attack) was found between the cilostazol group (8.2%, 246) versus control group (12.0%, 360; risk ratio .71 [.50-1.01], 95% CI). In addition, the cilostazol therapy brought about a nonsignificant reduction of cardiac adverse events (heart failure, myocardial infarction, and angina pectoris) comparing with control groups, with 3.8% (99) of the cilostazol group versus 4.7% (123) of control group (risk ratio, .81 [.62-1.04], 95% CI). Cilostazol, alone or in combination with aspirin, significantly reduces stroke recurrence, poststroke intracranial hemorrhage, and extracranial bleeding in patients with a prior ischemic stroke as compared with other antiplatelet therapies.

Safety of intravenous thrombolysis in stroke mimics: prospective 5-year study and comprehensive meta-analysis.

Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series. We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1. Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3-22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%-2%) and 0.3% (95% confidence interval, 0%-2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14-0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07-3.73; P<0.00001). Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM.

Pulmonary Complications in Patients with Brain Injury

The severity of brain injury is the main determinant of morbidity and mortality in neurocritical patients. However, the role of other associated extracranial complications should not be disregarded1 with pulmonary complications being among the most common ones (Figure 1).2 Major respiratory complications associated with injury to the Central Nervous System (CNS) are caused by airways dysfunction (inability to maintain passage due to neurologic depression or damage), respiratory muscles dysfunction (nerve injury) or intrinsic pulmonary disorders (infection, embolism, acute respiratory distress syndrome, etc.). The occurrence of such complications could potentially cause hypoxemia, which would secondarily aggravate the brain damage. This situation is known to account for up to 50% deaths resulting from brain injury and is considered to be an independent factor for mortality.1,3-8

Complications of Chronic Suppurative Otitis Media and Their Management: A Single Institution 12 Years Experience.

To determine the incidence of otogenic complications of Chronic suppurative otitis media (CSOM) and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient. The data were then compared with the relevant and available literature. Over the study period of 12years, a total 45 cases of CSOM with complications were reviewed. Out of these 45 cases, 20 cases had extracranial (EC) while 25 cases had intracranial (IC) complications. The prevalence of each complication was 0.17 and 0.13%, IC and EC respectively. The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered. The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus epidermidis were the common organism isolated. Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was main modality of management of these conditions. We observed that two patients fail to regain full facial nerve function despite of surgery. Mortality rate was zero but morbidity was seen in 15% (3) and 28% (7) of cases in EC and IC group respectively. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity. In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with multidisciplinary approach.

Abstract W P52: Safety of Intravenous Thrombolysis (IVT) in Stroke Mimics: A Prospective Five-year Study and Comprehensive Meta-analysis of Reported Case Series

Background&amp;Purpose: Shortening door-to-needle time may lead to intravenous thrombolysis (IVT) administration in stroke mimics (SM). We sought to determine safety of IVT in SM using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case series. Subjects&amp;Methods: We analyzed consecutive IVT-treated patients during a 5-year period (2009-2013) at a tertiary care stroke center. Non-contrast head CT, NIHSS pre-treatment and modified Rankin scores (mRS) at discharge were obtained as standard of care. SM was defined as no acute ischemic lesions on MRI and the final non-stroke diagnosis established by radiologists and treating physicians unaware of the purposes of this study. Symptomatic intracerebral hemorrhage (sICH) was defined as imaging evidence of ICH with NIHSS increase of 4 or more points. Functional independence (FI) was defined as mRS 0-1. We also conducted a comprehensive meta-analysis of all available case-series reporting safety of IVT in SM using PRISMA guidelines. Results: Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age 60±14years; median NIHSS 11, range 3-22), SM comprised 75 cases (14.5%, 95%CI by adjusted wald method: 11.7%-17.9%). sICH occurred in one patient (1.3%; 95%CI:0%-7.9%), while we documented no cases of orolingual edema (OE) or major extracranial hemorrhagic complications (0%; 95%CI:0%-4.2%). Two patients experienced minor extra-cranial hemorrhagic complications (1 case of gingival &amp; 1 case of nose bleeding). Meta-analysis of 9 studies including 8,942 patients treated with IVT and reporting safety outcomes in 392 SM showed pooled rates of sICH and OE 0.5% (95%CI: 0%-2%) and 0.3% (95%CI: 0%-2%) respectively. We documented no heterogeneity between estimates of sICH (I squared statistic=0%; p=0.941 Cohran Q test), and OE (I squared statistic=0%; p=0.913 Cohran Q test). Conclusions: Our prospectively collected data coupled with the findings of the comprehensive meta-analysis underscore the safety of IVT in SM given the low prevalence of hemorrhagic and systemic complications and the lack of heterogeneity across reported case-series.

Updates and Knowledge Gaps in Cholesteatoma Research

The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.

Antiangiogenic Therapies and Extracranial Metastasis in Glioblastoma: A Case Report and Review of the Literature.

We present a case report of a patient with glioblastoma multiforme (GBM) complicated by extracranial metastasis (ECM) whose survival of nearly four years surpassed the anticipated life expectancy given numerous negative prognostic factors including EGFRvIII-mutation, unmethylated MGMT promoter status, and ECM. Interestingly, while this patient suffered from locally aggressive disease with multiple intracranial recurrences, the proximal cause of death was progressive extracranial disease and complications related to pulmonary metastases. Herein, we review potential mechanisms of ECM with an emphasis upon glioblastoma molecular and genetic profiles and the potential implications of targeted agents such as bevacizumab.

Complications of chronic suppurative otitis media: challenge for a developing country.

This study aims to investigate the frequency and management of complications of chronic suppurative otitis media (CSOM). Out of 376 patients with CSOM, 44 patients (25 males, 19 females; mean age 48.5±3.5 years; range 21 to 76 years) meeting study criteria were enrolled in this descriptive cross sectional study which was conducted at the Department of Ear Nose and Throat, Head and Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. All newly diagnosed patients having CSOM with complications were enrolled. The complications were treated first. Intracranial abscesses were evacuated by neurosurgeons. Radical and modified radical mastoidectomy were performed. Majority of the patients presented in the second and third decade of life (21-30 years: 27.27%, 31-40 years: 18.18%). Most of the patients (59.1%) had lower socioeconomic status. Canal wall down mastoidectomy was the most common (79.5%) procedure performed. Cholesteatoma was the most common operative finding (100%). Among extracranial complications, subperiosteal abscess was the most common finding (38.63%), while extradural abscess outnumbered (22.72%) in intracranial complications. Complications of CSOM commonly affect younger people with low socioeconomic status. Collaborating with neurosurgeons may assist in the successful management of this infection.

Is duration of surgery a risk factor for extracranial complications and surgical site infections after intracranial tumor operations?

Duration of surgery has not been much explored as a possible risk factor for complications in neurosurgery. To explore the possible impact of duration of surgery on the risk of developing extracranial complications and surgical site infections following intracranial tumor surgery. Retrospective review of 1,000 consecutive patients who underwent planned surgery for intracranial tumors at a single institution. Complications within 30 days of surgery were registered. Of all patients, 18.6 % acquired extracranial complications, and they were seen in 14.3, 17.7, 22.1 and 37.4 % after operations lasting <2, 2-4, 4-6 and ≥6 h (p = 0.025). In multivariate analyses, duration of surgery per hour [OR 1.14 (1.04-1.25)], ASA 3-4 [OR 1.37 (1.14-1.63)] and acquired neurological deficits [OR 1.47 (1.02-2.11)] were associated with extracranial complications. For surgical site infections, there was a significant association between increased risk and increased duration of surgery (p < 0.001). Duration of surgery together with comorbidity and acquired neurological deficits is an independent risk factor for extracranial complications after brain tumor surgery. Duration of surgery is also associated with surgical site infections. Knowledge about the potential harm of slow surgery should be of interest to neurosurgeons when deciding on various surgical approaches, surgical tools or providing training. Also if acquiring ethical approval or informed consent in technical research projects, the risks associated with prolonging brain surgery should be considered. Special consideration should be warranted in patients with significant comorbidity, planned long surgery and higher risk of acquiring neurological deficits after surgery.

Prophylactic use of aspirin: systematic review of harms and approaches to mitigation in the general population.

A careful assessment of benefits and harms is required to assess suitability of aspirin as a prophylactic public health measure. However, comprehensive population-level data on harms are lacking. We collected and synthesized age and sex-specific data on harms relevant to aspirin use in average-risk individuals aged 50 years or older. We conducted systematic literature searches to identify baseline rates of gastrointestinal (GI) bleeding, peptic ulcer, major extra-cranial bleeding, and case-fatality rates due to GI bleeding or peptic ulcer in general population. The magnitude of aspirin-associated increase, the prevalence and attributable risk of Helicobacter pylori infection on these events in aspirin users was also assessed. Baseline rates of major extracranial bleeding events and GI complications increase with age; an almost threefold to fourfold increase is observed from age 50-54 to 70-74 years. Low or standard-dose aspirin use increases GI bleeding events by 60% leading to an annual excess of 0.45 and 0.79 GI bleeding events per 1,000 women and men aged 50-54 years respectively. 5-10% of major GI complications are fatal; a clear age dependence--higher fatality in older individuals, is seen. Eradication of H. pylori infection before aspirin use could reduce the incidence of upper GI complications by 25-30%. GI complications are increased by about 60% due to aspirin use but are fatal only in a very small proportion of individuals younger than 70 years of age. Major bleeding events that are comparable in severity to cancer or CVD, are infrequent. Screening and eradication of H. pylori infection could substantially lower aspirin-related GI harms.

MR Imaging Features of Acute Mastoiditis and Their Clinical Relevance

MR imaging is often used for detecting intracranial complications of acute mastoiditis, whereas the intratemporal appearance of mastoiditis has been overlooked. The aim of this study was to assess the imaging features caused by acute mastoiditis in MR imaging and their clinical relevance. Medical records and MR imaging findings of 31 patients with acute mastoiditis (21 adults, 10 children) were analyzed retrospectively. The degree of opacification in the temporal bone, signal and enhancement characteristics, bone destruction, and the presence of complications were correlated with clinical history and outcome data, with pediatric and adult patients compared. Most patients had ≥50% of the tympanic cavity and 100% of the mastoid antrum and air cells opacified. Compared with CSF, they also showed intramastoid signal changes in T1 spin-echo, T2 TSE, CISS, and DWI sequences; and intramastoid, outer periosteal, and perimastoid dural enhancement. The most common complications in MR imaging were intratemporal abscess (23%), subperiosteal abscess (19%), and labyrinth involvement (16%). Children had a significantly higher prevalence of total opacification of the tympanic cavity (80% versus 19%) and mastoid air cells (90% versus 21%), intense intramastoid enhancement (90% versus 33%), outer cortical bone destruction (70% versus 10%), subperiosteal abscess (50% versus 5%), and perimastoid meningeal enhancement (80% versus 33%). Acute mastoiditis causes several intra- and extratemporal changes on MR imaging. Total opacification of the tympanic cavity and the mastoid, intense intramastoid enhancement, perimastoid dural enhancement, bone erosion, and extracranial complications are more frequent in children.

Otogenic Brain Abscess: A Mini Review

Intracranial complications secondary to ear infections is an established clinical condition. The proximity of the brain compartments to the ear increases the chances of infections being percolated to central nervous system. Early clinical and laboratory diagnosis of such infections and better patient management strategies are required to minimize the intracranial and extracranial complications. Acute and chronic suppurative otitis media (CSOM) have been considered as risk factors for otogenic brain complications. Among the microbiological causes, recently there has been an increase in the cases of otogenic brain abscess due to Streptococcus spp . This review discusses the microbiological causes, implications, laboratory, diagnosis, and management of otogenic complications of central nervous system.