Öz
Akut mastoiditin neden olduğu otojenik beyin apsesi nadir görülen ancak potansiyel olarak ölümcül bir durumdur. Menenjit ve sigmoid sinüs trombozuna bağlı olarak daha da ilerleyebilen intrakraniyal bir komplikasyon oluşturur. Bu vaka, genellikle önemli klinik zorluklar oluşturan erken teşhis ve terapötik müdahalenin kritik öneminin altını çizmektedir. Bu yazıda, ağırlıklı olarak sağ tarafta görülen şiddetli otalji, akıntı ve vertigo ile gelen 35 yaşında bir kadın olgu sunulmuştur. Daha sonra yapılan nörogörüntüleme, sağ serebellar hemisferde bazal menenjit varlığını, ekstradural apse ve mastoid hava hücrelerinin birleştiğini ortaya koymuştur. Hastanın tedavi protokolü, semptomatik iyileşmeye göre sürekli olarak ayarlanan sıkı bir antibiyotik rejimini gerektirmiştir. Otojenik beyin apselerinin hızlı teşhisi ve acil tedavisi çok önemlidir. Olgumuzda da görüldüğü gibi, sınırlı tıbbi bilgi, tıbbi bakımda gözetim ve sosyo-ekonomik dezavantajlar gibi faktörler intrakraniyal komplikasyonun ciddiyetine katkıda bulunmuştur. Bu unsurlar, bu tür durumların etkili bir şekilde önlenmesi ve yönetilmesini sağlamak için sağlık hizmetlerinde sistemik faktörlerin ele alınmasının gerekliliğini vurgulamaktadır.
Anahtar Kelimeler
mastoidit menenjit vertigo serebral abse otojenik beyin absesi
Kaynakça
- Mahadevan M, Navarro-Locsin G, Tan HK, Yamanaka N, Sonsuwan N, Wang PC et al. A review of the burden of disease due to otitis media in the Asia-Pacific. Int J Pediatr Otorhinolaryngol. 2012;76:623-35.
- Novoa E, Podvinec M, Angst R, Gürtler N. Paediatric otogenic lateral sinus thrombosis: therapeutic management, outcome and thrombophilic evaluation. Int J Pediatr Otorhinolaryngol. 2013;77:996-1001.
- Secko M, Aherne A. Diagnosis of Bezold abscess using bedside ultrasound. J Emerg Med. 2013;44:670-2.
- Tandon S, Beasley N, Swift AC. Changing trends in intracranial abscesses secondary to ear and sinus disease. J Laryngol Otol. 2009;123:283-8.
- Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82:806-13.
- Sennaroglu L, Sozeri B. Otogenic brain abscess: review of 41 cases. Otolaryngol Head Neck Surg. 2000;123:751-5.
- Arlotti M, Grossi P, Pea F, Tomei G, Vullo V, De Rosa FG et al. GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) Working Group on Brain Abscesses. Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses. Int J Infect Dis. 2010;14:79-92.
- Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy. The rational use of antibiotics in the treatment of brain abscess. Br J Neurosurg. 2000;14:525-30.
- Mangi RJ, Peccerillo KM, Ryan J, Berenson C, Greco T, Thornton G et al. Cefoperazone versus ceftriaxone monotherapy of nosocomial pneumonia. Diagn Microbiol Infect Dis. 1992;15:441-7.
- Saito N, Aoki K, Sakurai T, Ito K, Hayashi M, Hirata Y et al. Linezolid treatment for intracranial abscesses caused by methicillin-resistant Staphylococcus aureus--two case reports. Neurol Med Chir (Tokyo). 2010;50:515-7.
Öz
Otogenic brain abscess, precipitated by acute mastoiditis, is a rare but potentially fatal condition. It constitutes an intracranial complication that can further develop due to meningitis and sigmoid sinus thrombosis. This case underscores the critical importance of early detection and therapeutic intervention, which often pose substantial clinical challenges. This report elucidates the case of a 35-year-old female who arrived with severe otalgia, noted predominantly on the right side, coupled with discharge and vertigo. Subsequent neuroimaging unveiled the presence of basal meningitis in the right cerebellar hemisphere, accompanied by an extradural abscess and coalescent mastoid air cells. The patient's treatment protocol entailed a rigorous antibiotic regimen, continually adjusted based on symptomatic improvement. The rapid diagnosis and immediate treatment of otogenic brain abscesses are paramount. As observed in our case, factors such as limited medical knowledge, oversight in medical care, and socio-economic disadvantages contributed to the severity of the intracranial complication. These elements highlight the necessity of addressing systemic factors in healthcare to ensure effective prevention and management of such conditions.
Anahtar Kelimeler
otogenic brain abscess mastoiditis meningitis vertigo cerebellar abscess
Kaynakça
- Mahadevan M, Navarro-Locsin G, Tan HK, Yamanaka N, Sonsuwan N, Wang PC et al. A review of the burden of disease due to otitis media in the Asia-Pacific. Int J Pediatr Otorhinolaryngol. 2012;76:623-35.
- Novoa E, Podvinec M, Angst R, Gürtler N. Paediatric otogenic lateral sinus thrombosis: therapeutic management, outcome and thrombophilic evaluation. Int J Pediatr Otorhinolaryngol. 2013;77:996-1001.
- Secko M, Aherne A. Diagnosis of Bezold abscess using bedside ultrasound. J Emerg Med. 2013;44:670-2.
- Tandon S, Beasley N, Swift AC. Changing trends in intracranial abscesses secondary to ear and sinus disease. J Laryngol Otol. 2009;123:283-8.
- Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82:806-13.
- Sennaroglu L, Sozeri B. Otogenic brain abscess: review of 41 cases. Otolaryngol Head Neck Surg. 2000;123:751-5.
- Arlotti M, Grossi P, Pea F, Tomei G, Vullo V, De Rosa FG et al. GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) Working Group on Brain Abscesses. Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses. Int J Infect Dis. 2010;14:79-92.
- Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy. The rational use of antibiotics in the treatment of brain abscess. Br J Neurosurg. 2000;14:525-30.
- Mangi RJ, Peccerillo KM, Ryan J, Berenson C, Greco T, Thornton G et al. Cefoperazone versus ceftriaxone monotherapy of nosocomial pneumonia. Diagn Microbiol Infect Dis. 1992;15:441-7.
- Saito N, Aoki K, Sakurai T, Ito K, Hayashi M, Hirata Y et al. Linezolid treatment for intracranial abscesses caused by methicillin-resistant Staphylococcus aureus--two case reports. Neurol Med Chir (Tokyo). 2010;50:515-7.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kulak Burun Boğaz |
| Bölüm | Editöre Mektup |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Aralık 2023 |
| Kabul Tarihi | 8 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 48 Sayı: 4 |
