Journal of Postgraduate Medicine
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CASE REPORTS
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Year : 1993  |  Volume : 39  |  Issue : 1  |  Page : 38-9  

Bilateral otogenic cerebellar abscesses.

TD Nadkarni, R Bhayani, A Goel, AP Karapurkar 
 Dept of Neurosurgery, Seth GS Medical College and KEM Hospital, Parel, Bombay, Maharashtra.

Correspondence Address:
T D Nadkarni
Dept of Neurosurgery, Seth GS Medical College and KEM Hospital, Parel, Bombay, Maharashtra.

Abstract

An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.



How to cite this article:
Nadkarni T D, Bhayani R, Goel A, Karapurkar A P. Bilateral otogenic cerebellar abscesses. J Postgrad Med 1993;39:38-9


How to cite this URL:
Nadkarni T D, Bhayani R, Goel A, Karapurkar A P. Bilateral otogenic cerebellar abscesses. J Postgrad Med [serial online] 1993 [cited 2019 Dec 8 ];39:38-9
Available from: http://www.jpgmonline.com/text.asp?1993/39/1/38/650


Full Text




  ::   IntroductionTop


Cerebellar abscesses following chronic suppurative otitis media is a well-known entity. However, bilateral cerebellar abscesses with bilateral ear infection was an unusual clinical presentation in two of our patients. Such an occurrence has not been reported earlier.


  ::   Case reportsTop


Case 1: A 9-year-old girl presented with complaints of bilateral otorrhoea for 18 months, intermittent fever for 2 months, headache, vomiting and progressive ataxia for 15 days. There were bilateral cerebellar signs and conductive hearing loss in both ears. Computed tomographic (CT) scanning showed two lateral cerebellar abscesses, the left one being the larger of the two [Figure:1]. X-rays of the mastoids showed bilateral cholesteatoma with mastoiditis. Both abscesses were excised at the same sitting through bilateral retro-mastoid craniectomies. The following day the patient underwent bilateral mastoidectomy. The child had an uneventful recovery. The pus yielded no bacterial growth. Antibiotics were continued empirically for 3 weeks.

Case 2: A 14-year-old boy presented with left otorrhoea for 10 months and right otorrhoea for 1 month. For 10 days, the child had headache, vomiting, intermittent fever, nuchal pain and irrelevant behaviour. There was bilateral papilloedema, bilateral cerebellar signs, and bilateral conductive hearing losses.

CT scan showed [Figure:2] a larger left and a smaller right cerebellar abscess. X-rays showed bilateral mastoiditis. The left cerebellar abscess was excised, followed on the next day by mastoidectomy on the same side. It was felt that the right abscess being small would respond to antibiotic treatment. However, the patient continued to be ill and febrile. CT scanning was repeated after 2 weeks, which showed a marked enlargement of the right-sided abscess [Figure:3]. Subsequently, it was excised. The patient rapidly improved. Pus culture revealed no growth of organisms.


  ::   DiscussionTop


Cerebellar abscesses following ear infection are common[1],[2],[3]. However, bilateral cerebellar abscesses following bilateral chronic suppurative otitis media was an unusual presentation in our patients. Both these patients belonged to the lower socioeconomic class. It is difficult to confirm whether the nutritional status with some immuno-deficient state, or a congenital defect in the petrous bones had an aetiological role. Both the patients had no evidence of infection anywhere in the body and had no signs of an over immune disorder. Pus in both these cases yielded no growth on culture. This may be due to the pre-operative antibiotic therapy that the patient received for otitis media. Excision of the abscesses, early management of the primary ear disease with an appropriate course of antibiotic is the therapeutic approach of choice.

References

1 Shaw MD, Russell JA. Cerebellar abscess. A review of 47 cases. J Neurol Nerosurg Psychiatr 1975; 38:429-435.
2Yang SY. Brain abscesses - a review of 400 cases. J Neurosurg 1981; 55:794-799.
3Unnikhshnan M. Posterior fossa abscesses. A review of 33 cases. J Assoc Physicians India 1989; 37:376-378.

 
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