otogenic brain abscess
Introduction
Introduction to otogenic brain abscess Otogenic brain abscess refers to a brain abscess caused by middle ear infection invading the brain. It is a serious complication of suppurative otitis media, which is life-threatening; it is complicated by cholesteatoma otitis media. Abscesses are mostly located in the temporal lobe, followed by the cerebellum, and other abscesses and multiple abscesses are rare. Otogenic brain abscess is the most common and severe case of various intracranial complications. The clinical features are mainly fever, headache, varying degrees of disturbance of consciousness and some localized symptoms of the nervous system. Brain CT Scanning is important for early diagnosis. The prognosis of this disease is poor, and early and appropriate treatment can often reduce mortality. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: ventriculitis meningitis
Cause
Etiology of otogenic brain abscess
The formation of brain abscess can generally be divided into three stages:
(1) Localized encephalitis period: brain tissue congestion, edema, inflammatory cell infiltration, and later some brain tissue softened and necrotic, and many small liquefaction zones appeared.
(B) the suppuration phase: the liquefaction zone is fused to form an abscess.
(C) the formation period of the capsule: after 3 to 4 weeks, the granules, fibrous connective tissue and glial cells form a capsule around the abscess, and the capsules are thick and thin, and the brain tissue around the capsule is edematous. The abscess continues to increase, and the surrounding tissue is compressed, which can produce localized signs. If it collapses into the nearby ventricle or subarachnoid space, it forms severe ventriculitis and meningitis, and even causes fatal fulminant meningitis. If the intracranial pressure rises significantly High, brain tissue shift, then the formation of cerebral palsy, temporal lobe abscess often occurs in the cerebellar incision, cerebellar abscess is more common in the occipital foramen, can occur breathing, rapid cardiac arrest and rapid death.
Prevention
Otogenic brain abscess prevention
This disease often coincides with other otogenic intracranial complications. If the treatment of ear disease is neglected during treatment, it often leads to death or recurrence of abscess. This disease is caused by otitis media not being treated promptly or improperly treated. Therefore, patients should remember:
1. Suffering from otitis media should be examined regularly to determine whether it is a dangerous "cholesteatoma type";
2. Because the ear canal is already narrow, don't believe that "the river and the liver doctor. Inject the insoluble powder into the inside. Once the medicine and the pus form a hard block to block the ear canal, the pus can not flow out, then invade the skull and cast a big mistake. The disease is serious, and patients should be sent to hospital for treatment.
Complication
Otogenic brain abscess complications Complications, ventriculitis, meningitis
Often due to cerebral palsy or ventriculitis, outbreaks of diffuse meningitis die.
Symptom
Symptoms of otogenic brain abscess Common symptoms Meningeal irritation sign Increased intracranial pressure Brain abscess Meningitis Low fever coma
The clinical manifestations of brain abscess can be divided into four phases:
(A) onset: about a few days, there are chills, fever, headache, vomiting and mild meningeal irritation and other early localized encephalitis or meningitis.
(B) incubation period: for 10 days to several weeks, no obvious symptoms, or irregular headache, low fever, and sleepiness, depression, irritability, less language and other mental symptoms.
(3) Symptoms: The duration is different, the abscess is formed, and various symptoms appear.
1. Toxic symptoms: such as fever or normal body temperature, or below normal, loss of appetite, general weakness.
2. Increased intracranial pressure symptoms: 1 headache is severe, more persistent, often worsened at night, 2 vomiting is spray-like, not related to diet, 3 disturbances of consciousness, such as apathy, lethargy, even coma, 4 pulse delay, and body temperature Inconsistent, 5 can appear papilledema, 6 other: such as yawning, frequent unconscious movements (digging nose, touch the testicles, etc.), personality and behavior changes.
3. Focal symptoms: focal symptoms may be early or late, or not obvious.
Temporal lobe abscess: 1 pair of lateral hemiplegia, 2 contralateral central facial paralysis, 3 aphasia, 4 contralateral limb tonic spasm, ipsilateral pupil dilated or contralateral pyramidal sign.
Cerebellar abscess: 1 central nystagmus, 2 ipsilateral limb muscle tension weakened or disappeared, 3 ataxia, such as finger nose is not allowed, wrong refers to the level, rotation dyskinesia, gait sputum and so on.
(D) the final stage: often due to cerebral palsy or ventriculitis, outbreaks of diffuse meningitis die.
Examine
Examination of otogenic brain abscess
1. CT scan of the head: It can show the size and position of the abscess, which is of great significance for the early diagnosis of brain abscess.
2. Brain ultrasound examination: On-screen abscess can occur in the midline wave shift.
3. Carotid cerebral angiography: has a diagnostic significance for brain abscess, but does not help the diagnosis of cerebellar abscess.
4. Abscessive diagnostic puncture: In addition to the exploration of the skull bottom spur, it can still be used for diagnostic puncture through the mastoid cavity. Those with increased intracranial pressure should be cautious in the lumbar puncture to prevent cerebral palsy.
Diagnosis
Diagnosis and diagnosis of otogenic brain abscess
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Attention and hydrocephalus, brain tumor identification, otogenic brain hydrops are two types of traffic hydrocephalus and obstructive hydrocephalus, but more common with traffic hydrocephalus, hydrocephalus increased with intracranial pressure As the main symptoms, systemic symptoms are mild, no focal symptoms, brain CT scan or MRI can be identified, brain tumors develop slowly, no history of suppurative otitis media and intracranial infection symptoms.
