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Year : 2001  |  Volume : 49  |  Issue : 1  |  Page : 101

Otogenic intracranical suppuration at a rare site - letter to editor.






How to cite this article:
Salahudeen M M, Inbasekaran V, Kumar N A, Rajan D K, Sivakozhundu M K. Otogenic intracranical suppuration at a rare site - letter to editor. Neurol India 2001;49:101


How to cite this URL:
Salahudeen M M, Inbasekaran V, Kumar N A, Rajan D K, Sivakozhundu M K. Otogenic intracranical suppuration at a rare site - letter to editor. Neurol India [serial online] 2001 [cited 2020 Jan 19];49:101. Available from: http://www.neurologyindia.com/text.asp?2001/49/1/101/1286



A 16 years old female was admitted with headache,
fever and irritability for 20 days. She had left ear
sepsis since her childhood. Examination revealed
signs of meningeal irritation. She had no focal or long
tract signs. Other systems were normal. CT brain,
plain and contrast study [Figure:1a] and [Figure:1b] showed left
temporal lobe abscess (stage III) with left sylvian
cortical enhancement and anterior and posterior
loculated subdural empyema (SDE) in the parafalcine
region on left side. Left temporal abcess was tapped
and loculated SDE were removed by appropriate
craniotomies. Patient had a stormy post operative
period for 48 hours and subsequently recovered.
Follow up CT [Figure:1c] done on 7th post operative day
showed complete resolution of left temporal abcess
and marked reduction of SDE. Antibiotics and
anticonvulsive medication were continued. After full
recovery, she was subjected to mastoidecomy.
SDE is often a complication of otitis media1,2 and
paranasal sinusitis[3],[4],[5] and constitute to 13-23% of
localised intracranial suppuration. The freely moving
subdural pus organises into separate pockets,[12]
usually over the convexities.3 Rarely, they collect over
parafalcine[3],[5] region which is difficult to access
surgically, and constitute to 3.2% of localised
intracranial suppuration.[10],[11] Medical treatment alone
is not adequate in treating SDE and the loculations
need to be drained, to prevent chronic suppuration.[3],[10]
Reported mortality is 21-35% and morbidity is about
20%.[5] Early diagnosis, prompt surgical intervention
with long term antibiotic therapy and eradication of
primary source are mandatory for complete recovery
as in our case.

 

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1.Balakrishnan D, Natarajan M : J Indian Med Assoc 1971; 57 : 87-91.  Back to cited text no. 1    
2.Inbasekaran V, Natarajan M : Brain abscess - Recent experience. J Indian Med Assoc 1984; 82 : 391-393.  Back to cited text no. 2    
3.Bernardo B, Jacob Silvia H, Henry Z et al : Supratentorial and parafalcine subdural empyema diagnosed by CT: Case Report. J Neurosurg 1981; 54 : 105-107  Back to cited text no. 3    
4.Stanapheno S, Jourbert MJ, Welchman JM : Combined convexity and parafalx SD empyema; Surgical treatment. Surg Neurol 1979; 11 : 147-151.  Back to cited text no. 4    
5.Narendra Nathoo, Syed SN, James Van Dellen JR et al : Intracranial SPG in the CT era: A review of 699 cases. J Neurosurg 1999; 44 : 529-536.  Back to cited text no. 5    

 

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