Temporal Lobe Abscess Research Articles

Otogenic brain abscess as a complication of acute otitis media in an adult female patient – a case report and literature review

<b>Introduction:</b>Ear abscess of the brain occurs in 0.3–1.3/100,000 of the population per year, and about 30% of abscesses are accompanied by other intracranial complications. Such complications can occur in the course of both chronic and acute otitis media, but the latter is extremely rare.<b>Aim:</b> To present a case of temporal lobe abscess in the course of acute otitis media (AOM) in an adult.<b>Case study: </b> The patient was admitted to the Hospital Emergency Department (ED) with symptoms of AOM with purulentleakage from the right ear and disturbance of consciousness. In addition to inflammatory changes in the middle ear, a CTscan showed zones of swelling in the right temporal lobe with suspicion of a forming temporal lobe abscess on the rightside. The treatment administered included urgent anthromastoidectomy and right-sided tympanostomy, as well as empiricalantibiotic therapy. Six days after admission, a follow-up magnetic resonance imaging (MRI) scan of the brain showedprogression of the lesions, complete formation of the abscess, and thrombotic changes in the cerebral venous sinuses werealso described. Further treatment included drainage of the temporal lobe abscess. A significant improvement in generaland neurological condition was achieved. Conservative treatment was continued and regression of the right temporal lobeabscess was achieved, and a follow-up RM study confirmed stable thrombotic lesions in the right transverse sinus.<b>Conclusions:</b> The occurrence of intracranial complications in the course of AOM in adults is extremely rare. Deterioration of the general condition and the appearance of consciousness disturbances in the course of AOM may indicate developing intracranial complications. Implementation of multidisciplinary diagnostic and therapeutic management makes it possible to achieve good therapeutic results.

Clinical analysis, diagnosis, and treatment strategies for otogenic brain abscesses.

Objective: To explore the clinical features, diagnosis, and treatment strategies for otogenic brain abscesses (OBA). Methods: Clinical data from 10 patients with OBA were analyzed retrospectively. Clinical characteristics, diagnosis, and treatment experiences were summarized. Results: Two were first diagnosed in the Department of Otorhinolaryngology, 5 in Neurosurgery, and 3 in other departments. There were 6 cases of temporal lobe abscess and 4 cases of cerebellar abscesses. Five cases were accompanied by 1 or more intracranial complications. Headache is a common presentation in all cases. The main pathogenic bacteria were anaerobic bacteria. All patients had no previous ear or brain surgery history, and no history of traumatic brain injury, 7 received surgical treatment in the neurosurgery and/or otolaryngology department. Two patients died, the other 8 fully recovered and so were discharged. Conclusions: Diagnosis and treatment of OBA must involve multiple departments. Multidisciplinary consultation (MDT) is crucial to the success of the first OBA diagnosis. The diagnosis and treatment team develops personalized treatment plans by integrating MDT treatment opinions and combining the actual condition of patients, thereby making the diagnosis and treatment of OBA accurate and timely.

Rhinocerebral mucormycosis (RCM): To study the clinical spectrum and outcome of 61 cases of RCM managed at a tertiary care center in India.

Mucormycosis is a life-threatening infection of the paranasal sinuses and nasal cavities that can easily spread to the orbit and the brain. It is caused by fungi of the family Mucoraceae. We present a case series of 61 patients diagnosed and treated for rhinocerebral mucormycosis (RCM) at a single tertiary health care center. After obtaining ethical clearance, all patient files with a final diagnosis of RCM were thoroughly analyzed in departmental records and a master chart was prepared. The study evaluated the etiology, clinical spectrum, diagnosis, management, complications, and outcome at 3 months of RCM cases. About 93.4% of the RCM cases were diabetic and an equal number had a past history of COVID infection. About 85.2% had received steroids for the treatment of coronavirus disease 2019 infection. The most common presentation of RCM was temporal lobe abscess (25.7%) followed by frontal lobe abscess (16.6%). At 3 months post-diagnosis, mortality in our study was 42.6%. About 26.2 % of the RCM cases had no disease, 23% had a static disease, and 8.2% had progressive disease at the end of 3 months. We report the largest single-center case series of RCM, comprising 61 patients. This case series underscores the importance of the early diagnosis and prompt treatment for a better prognosis for this dreadful disease. The three pillars of treatment for RCM cases include reversal of the immunosuppressive state, administration of antifungal drugs, and extensive surgical debridement. In spite of all this, mortality remains high.

MANAGEMENT OF COVID ASSOCIATED ORBITAL MUCORMYCOSIS IN TERTIARY CARE HOSPITAL

Objectives: The aim of the study was to study epidemiological characteristics and management of orbital mucormycosis in cases of rhino-orbital mucormycosis in tertiary care hospital. Methods: It is a retrospective study of 258 patients presenting to KGH, Visakhapatnam, over a duration of 3 months from June to August 2021. After taking detailed history regarding symptoms of mucormycosis, visual acuity was noted, slit lamp examination was done and necessary investigations such as microbiology, pathology specimens were sent and analyzed, imaging done, and management done accordingly. Results: The majority of patients came with ENT-related symptoms were treated with endoscopic debridement, that is, 216 (84%), endoscopic debridement with orbital decompression of 23 (9%), transcutaneous retrobulbar amphotericin B of 21 (8%), orbital exenteration of 17 (6.5%), total and partial maxillectomy of 28 (10.8%), temporal lobe abscess drainage of 7 (2.7%), frontal lobe abscess drainage of (1.16%), frontal bone abscess drainage of 3 (1.16%), dural abscess drainage of 6 (2.3%), 15 (5.8) treated conservatively, and 30 (11.6%) death. Conclusion: COVID-19 infection in presence of glycemic dysregulation predisposes to development of Rhino-orbital-cerebral mucormycosis. Strict glycemic control and judicious use of corticosteroids might help in decrease incidence of mucormycosis cases. Most of the patients presents with ENT-related symptoms if not treated early may spread to orbit and intracranial sites. Early treatment during early presentation might help prevent spreading orbital extension and intracranial extension.

An Eight Year Clinico-Microbiological Retrospective Study on Brain Abscesses in India.

Background:Intracranial abscesses have been a diagnostic and therapeutic challenge since time immemorial for both the microbiologists and the neurosurgeons. There is paucity of detailed studies documenting the infecting organism causing brain abscesses in South India.Aims:The study aimed at identifying and assessing the prevalence of aerobic, anaerobic bacteria and fungi associated with brain abscesses at a tertiary care hospital in South India.Methods and Material:Eight years data was collected from the records of culture reports from 2007 to 2010 and 2013 to 2018. The corresponding clinical case records were retrieved for the assessment of risk factors. Risk factors of brain abscess development were assessed based on clinical cases records.Results:Data from 140 brain abscess cases obtained over a period of 8 years were analyzed. Out of the 140 samples, 66 (47.14%) were culture positive in which 33 (50%) had single aerobic/facultative anaerobic bacteria, 20 (30.3%) had mixture of more than one aerobic/facultative anaerobic bacteria, 12 (18.18%) had single obligate anaerobic bacteria and 1(1.5%) sample had Mycobacterium tuberculosis isolated. Among the total 92 isolates, Pseudomonas aeruginosa (21/92, 23%) and Staphylococcus aureus (20/92, 22%) predominated. Bacteroides fragilis group was the most common obligate anaerobe isolated. There were no fungal isolates. As there were various isolates isolated, hence there is heterogeneity of isolates detected Neuroanatomically, parietal lobe (45/140, 32%) was the most common location. Otogenic infection was the major risk factor for parietal and temporal lobe abscess (P value < .05).Conclusions:It has become essential for the microbiologists to be aware of unusual isolates from brain abscess and its complex nature. Obscurity and difficulty in their microbiological diagnosis calls for more such detailed studies.

Acute Fulminant Mucormycosis Triggered by Covid 19 Infection in a Young Patient.

Covid 19 infection can result in various opportunistic infections. Altered immune response, associated comorbid conditions like diabetes, prolonged steroid and broad spectrum antibiotics usage with ICU interventions lead to increased chance of such superadded infections in covid 19 patients. Here we report a case of 31 year old male with covid 19 infection who had new onset Diabetes Mellitus, developed severe acute fulminant Mucormycosis during the treatment for covid 19 infection. He presented with severe headache, nasal obstruction and discharge, bilateral ophthalmoplegia and blindness with Cavernous Sinus Thrombosis. Patient underwent aggressive surgical debridement with frontal craniectomy, maxillectomy and right orbital evisceration and left endoscopic orbital decompression and judicious efforts to revert back the immunocompromised status with high dose of Liposomal amphotericin. Post operatively patient developed right temporal lobe abscess which was drained through Endonasal Endoscopic Trans Cavernous drainage of Temporal Lobe Abscess. Patient is in 2 months follow up, with bilateral blindness and tolerating oral feeds with improved left eye ophthalmoplegia. It is imperative to note that the rising trend of mucormycosis is there in Covid 19 infections and it should be dealt with high index of suspicion in high risk patients and early aggressive treatment can save the patient as the survival rate is not high in such infections.

Plasma Ablation−Assisted Endoscopic Endonasal Transpterygoid Approach to Sphenoid Lateral Recess Cerebrospinal Fluid Leaks: Technique and Outcome

Management of sphenoid lateral recess (SLR) cerebrospinal fluid (CSF) leaks present a challenge because of the location and requiring complete visualization of the defect for a successful repair. The endoscopic endonasal transpterygoid approach (EETPA) is considered the gold standard in addressing these defects. We lay out our experience in implementing this approach with plasma ablation. This is a case series of 11 diagnosed patients of SLR CSF leaks who underwent plasma ablation-assisted EETPA repair by a single surgeon between 2011 and 2020 at our institution. Outcomes in terms of surgical field grade on the Wormald 11-point grading scale, postoperative complications, healing on nasal endoscopy and imaging, and surgical success rate were assessed. The etiology was spontaneous leak in 10 (90.9%) patients and secondary to temporal lobe abscess and/or meningitis in one (9.09%). Three (27%) patients were previously operated elsewhere by the transsphenoidal route, which we reoperated by this technique. As per Wormald grading, grade 1 field in 3 (27.27%), grade 2 in 6 (54.5%), and grade 3 in 2 cases (18.18%) were noted. Complications occurred in 3 patients (27%) in the form of dry eye (9%), meningitis (9%), and transient CSF rhinorrhea in the immediate postoperative period (9%). Repair sites were well healed on follow-up nasal endoscopy and imaging. The surgical success rate was 100%. Plasma ablation-assisted EETPA allows for a uninostril approach to the SLR, easy accessibility, and better visualization with a bloodless field, which allows appropriate repair, thus minimizing complications and preventing recurrence.

Complications of chronic suppurative otitis media and their management: five year study at tertiary care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media is a disease that can end up in complications when treatment is delayed. The present prospective study was conducted at our tertiary care hospital and teaching centre to evaluate the incidence of complications of CSOM and their management.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We analysed the clinical and intra operative findings, type of medical and surgical management and recovery of the patient. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total 20 cases of CSOM with complications were reviewed in study period of 5 years. Of these 20 cases, 14 cases had extracranial (EC) while 6 cases had intracranial (IC) complications. The encountered IC complications were brain abscess ie temporal lobe abscess, pyogenic meningitis, lateral sinus thrombophlebitis and extradural abscess. Among the EC complications, mastoid abscess, Bezolds abscess, zygomatic abscess and labyrinthitis were encountered. The IC complications presented with fever, headache, and signs of meningeal irritation. &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt;, &lt;em&gt;Proteus&lt;/em&gt;, &lt;em&gt;Staphylococcus epidermidis&lt;/em&gt; and &lt;em&gt;E. coli&lt;/em&gt; were the common organisms isolated. Both groups of patients had cholesteatoma and middle ear granulations. Surgery was the main modality of treatment with zero mortality rate. We reviewed the clinical presentation and management in both groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; CSOM complications, inspite of their reduced incidence still pose a great challenge in developing countries. When the disease presents late, it lead to difficulty in management and consequently higher mortality. Our study emphasizes the importance of early diagnosis and prompt management.&lt;/p&gt;

Faciocranial complications of sinusitis

Sinusitis is one of the most common conditions. The aetiology of sinusitis has not been fully discovered; however, viruses and bacteria are usually the dominant causes. The chief symptoms include nasal congestion, profuse nasal discharge and a compromised sense of smell. Inflammation of any sinus can be the source of complications. Complications develop usually as a result of exacerbation of chronic sinusitis. Sinusitis may result in inflammation spreading inside the cranium and to the orbital area and in the development of osteomyelitis or superior sagittal sinus thrombosis. Due to the anatomical location and proximity of important structures, sphenoid sinusitis may lead to meningitis or subdural empyemas, temporal lobe abscesses and cavernous sinus thrombosis. Fungal sinusitis is very dangerous since it is characterised by a rapid course often complicated by intracranial and orbital spread. Invasive fungal paranasal sinusitis with orbital complications is a life-threatening emergency. If there is concern about possible orbital or intracranial complications of sinusitis or if there is no improvement after initial empirical therapy, the use of diagnostic imaging is necessary, including computed tomography and magnetic resonance imaging. Early diagnosis of sinusitis and multidisciplinary management involving a combination of antibiotic therapy and surgical treatment, including neurosurgery and maxillofacial procedures can be effective in the prevention of complications and may significantly reduce morbidity and mortality.

A Case of Temporal Lobe Abscess Caused by Foreign Bodies in the External Auditory Meatus Discovered at a Visit for Speech Impairment

A Case of Temporal Lobe Abscess Caused by Foreign Bodies in the External Auditory Meatus Discovered at a Visit for Speech Impairment

A Case of Chronic Otitis Media Complicated with Cerebellar Abscess

Introduction:Intracranial complications are a known sequale of chronic otitis media. Meningitis is the most common intracranial complication, followed by otogenic brain abscess. Temporal lobe abscesses are more frequently reported in the literature as compared to cerebellar abscesses.Case Report: We present a case of chronic otitis media with cerebellar abscess that need drainage of the abscess twice. The mastoidectomy was done few days later once the patient stable.Conclussion: The case report highlights the increasing incidence of cerebellar abscess as an intracranial complicationwith literatures review. Besides that, we also discuss about the appropriate timing of ear surgery and neurosurgical drainage, as well as its outcome.Bangladesh Journal of Medical Science Vol.17(1) 2018 p.149-151

An Algorithm for CSF Leak Management in a Spectrum of Temporal Bone Pathologies

Introduction: A wide spectrum of temporal bone pathology can present with cerebrospinal fluid (CSF) leak. This originates from the defects in the temporal bone that can be spontaneous, traumatic, pathological and iatrogenic. Most common routes are from labyrinthine window dehiscence, along fracture lines, via inner ear malformations or by direct dural invasion due to middle ear pathology. Complications of CSF leak include otogenic meningitis, temporal lobe abscess and otic hydrocephalus. Methods: This is a case review of three interesting patients, who presented with varied etiology of CSF leaks. Their complex pathology and the rationale in management of CSF leaks are highlighted. Case 1: Post road traffic accident (RTA) bilateral temporal bone fracture with unilateral CSF otorhinorrhea with total facial palsy with profound Sensorineural hearing loss (SNHL). Case 2: Petrous cholesteatoma recurring in a previous mastoid cavity with large tegmen and dural erosion, fungus cerbri and CSF leak. Case 3: Adolescent girl with unilateral cochleovestibular dysplasia presenting with recurrent meningitis due to spontaneous CSF otorhinorrhea. Results: All patients had successful repair of defects to achieve complete arrest of leak by following meticulous approach with a multi-layered closure and post-operative management with neuro monitoring. Based on our experience we recommend a standard protocol for CSF leak repair in the temporal bone. Conclusion: CSF otorrhea is a rare entity. Diagnosis is suspected through otorrhea, aural fullness, hearing loss and radiological investigations. Surgery is successful when managed at a tertiary referral centre having an experienced skull base team, using a protocol as suggested here.

Otogenic Temporal Lobe Abscess: A Mini-review

Temporal lobe abscess is a rare, life threatening complication of inflammation of the middle ear. Signs of intracranial tension or focal neurological deficits at the time of presentation in patients with chronic or acute otitis media should raise concerns for temporal lobe abscess. Immediate surgical intervention along with antibiotics is necessary for good outcome.

Expressive aphasia caused by &lt;em&gt;Streptococcus intermedius &lt;/em&gt;brain abscess in an immunocompetent patient

BackgroundBrain abscess is an uncommon but life-threatening infection. It involves a focal, intracerebral infection that begins in a localized area of cerebritis and develops into a collection of pus, surrounded by a well-vascularized capsule. Brain abscess still poses a significant problem in developing countries but rarely in developed countries. Predisposing factors vary in different parts of the world. With the introduction of antibiotics and imaging studies, the mortality rate has decreased between 5% and 15%. If left untreated it may lead to serious neurologic sequelae. The temporal lobe abscess can be caused by conditions like sinusitis, otitis media, dental infections, and mastoiditis if left untreated or partially treated. Additionally, in neurosurgical procedures like craniotomy, the external ventricular drain can get infected, leading to abscess formation.Case presentationWe present the case study of an elderly female patient who presented with expressive aphasia caused by brain abscess, secondary to Streptococcus intermedius infection. The 72-year-old female with a medical history of hypertension came to hospital for evaluation with word-finding difficulty, an expressive aphasia that began a few days prior to presentation. Computed tomography of the head showed a left temporal lobe mass-like lesion, with surrounding vasogenic edema. The patient was empirically started on courses of antibiotics. The next day, she was subjected to magnetic resonance imaging of the brain, which showed a left temporal lobe septated rim-enhancing mass lesion, with bright restricted diffusion and diffuse surrounding vasogenic edema consistent with abscess. The patient was also seen by the neurosurgery department and underwent stereotactic, left temporal craniotomy, with drainage, and resection of abscess. Tissue culture grew S. intermedius sensitive to ampicillin sulbactam. Subsequently her expressive aphasia improved.ConclusionBrain abscess has a high mortality, however a significant proportion of patients with appropriately treated abscess recover completely and can survive without significant neurologic damage. Advanced imaging modalities may yield more accurate methods of differentiation of mass lesions in the brain. Biopsy of brain lesion with early initiation of appropriate antibiotics will change the outcome.

Combination of drainage and chemotherapy for treatment of a Staphylococcus aureus brain abscess in a pre-term infant

Introduction: Neonatal brain abscess is an uncommon intracranial suppuration that usually occurs as a complication of bacterial meningitis or septicaemia. Staphylococcus aureus rarely causes brain abscesses during the first months of life. Case presentation: A case of a premature infant who developed cerebellar, left temporal and left occipital lobe abscesses after S. aureus sepsis is presented. The pus provided the same S. aureus strain of the sepsis. The patient was treated with vancomycin for 37 days, accompanied by extraction of the purulent material. The abscesses resolved and no sequelae remained. Conclusion: It appears that long antibiotic treatment regimes, when associated with early pus drainage, are effective in resolving infection and abscesses caused by S. aureus in neonates.

Otogenic brain abscess: A rising trend of cerebellar abscess an institutional study

Chronic inflammation of the middle ear is the most frequent cause of otogenic complications. Meningitis is the most frequent intracranial complications, followed by otogenic brain abscess in neglected otitis media. Although temporal lobe abscesses are more common than cerebellar abscesses, the converse was found to be true in our series of 17 cases. 16 cases of cerebellar abscess and 1 case of temporal lobe abscess were reported as a complication of chronic otitis media (COM). In our group of patients, otogenic brain abscesses were more frequent in male patients of age group 5–20 years with mean age of 14 years. Diagnostic procedure included history, clinical, otorhinolaryngological examination, audiological, microbiological, neurological, ophthalmological, and radiological examinations. The treatment included primary neurosurgical approach (abscess drainage) followed by radical otosurgical treatment.

English

Complication of otitis media is defined as a spread of infection beyond the pneumatised area of temporal bone and associated mucosa. Though introduction of antibiotics has decreased the incidence of intracranial complications, they still occur in unrecognized, poorly managed or resistant cases which lead to morbidity and mortality. Here we report a case of chronic otitis media with recurrent temporal lobe abscess leading to mortality.

A Case of Temporal Lobe Abscess Following Mastoidectomy

We report a case of complicated temporal lobe abscess following mastoidectomy. The patient complained of a headache after surgery, however, he was discharged as his symptom was considered to be a common postoperative headache. He revisited our due to a generalized tonicclonic seizure, and the CT and MRI findings suggested the diagnosis of temporal lobe abscess. The patient was successfully treated with antibiotics instead of surgical treatment. Although the cerebral abscess following mastoidectomy is extremely rare, it is necessary to pay attention to it. Particularly when the patient complains of a headache, it is important to consider the aspects of headache carefully. Bone defect in tegmen tympani and exposure of dura will increase the risk of cerebral abscess, therefore careful caution is required in the presence of lower dura mater.

Extensive intratemporal cholesteatomas: presentation, complications and surgical outcomes

The purpose of the study was to review the clinical features, complications, surgical management and post-operative outcomes of medially invasive extensive cholesteatomas and intracranial complications of cholesteatoma. The retrospective review was carried out at a tertiary referral center and included 20 patients presenting with extensive intratemporal cholesteatomas between 2011 and 2013. Inclusion criteria were involvement of the labyrinth, facial nerve, posterior fossa dura and intracranial complications. The mean age of the patients was 20 years. Profuse foul-smelling otorrhoea and severe otalgia/temporal headache were the most common presenting features. Intracranial complications were observed in nine patients, most commonly temporal lobe abscess; 14/20 patients exhibited profound hearing loss. One case exhibited massive labyrinthine petrous apex cholesteatoma. Labyrinthine destruction was seen in all cases of facial nerve involvement. Management of intracranial complications preceded canal wall-down mastoidectomy with or without partial labyrinthectomy and subtotal petrosectomy (transotic) with blind sac closure for petrous cholesteatoma. Facial nerve infiltration was observed in one case, whereas eight cases exhibited gross dehiscence of the fallopian canal. Disease clearance was complete in all cases with two mortalities in patients with intracranial complications. Post-operative course was uncomplicated in all other patients apart from a case of wound dehiscence. All patients remain disease free after a minimum and maximum follow-up of 6 months and 2 years, respectively. Extensive intratemporal cholesteatomas and intracranial complications caused by them continue to pose a challenge to the management of otitis media in the current era and merit early recognition, surgical management and follow-up.

Carcinoma Middle Ear with Facial Nerve Palsy and Temporal Lobe Abscess

Carcinoma of middle ear is very rare condition being one in 20,000 new patients. The commonest primary middle ear malignancy is usually squamous cell carcinoma. A 36-year-male presented with right sided severe earache with blood stained aural discharge, associated with headache and deviation of angle of the mouth to the opposite side. He had ear discharge since childhood. On examination he had bleeding polypoidal mass in the right external auditory canal &amp; tympanic membrane was not visualized. He also had features of facial nerve palsy. CT scan of brain finding was chronic right mastoiditis &amp; right temporal lobe abscess causing significant mass effect. The patient was undergone Burr-hole operation. After 2 weeks right radical mastoidectomy was done. There was huge granulation tissue involving middle ear, attic &amp; mastoid antrum and ossicles was eroded. Histopathology report revealed infiltrating squamous cell carcinoma grade-I. The patient was sent for radiotherapy &amp; asked for follow up monthly. In long standing chronic suppurative otitis media with blood stained discharge &amp; facial nerve palsy, middle ear malignancy should be suspected. Anwer Khan Modern Medical College Journal Vol. 4, No. 2: July 2013, Pages 49-51 DOI: http://dx.doi.org/10.3329/akmmcj.v4i2.16943