Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 51, Num. 2, 2003, pp. 294

Neurology India, Vol. 51, No. 2, April-June, 2003, pp. 294

Letter to Editor

Spontaneous evacuation of cerebellar abscess through the middle ear

P. K. Upadhyay, G. Tiwary
Consultant Neurosurgeon, Medical College Hospital Raipur, Chhattishgarh, India.

Accepted on 22.09.2001.

Code Number: ni03104

Sir,

Brain abscess is an important cause of morbidity and mortality, especially in under- developed countries where the incidence is around 8% of all brain-space-occupying lesions.¹ The treatment of brain abscess has changed over the years. The surgical protocol ranges from open surgical resection of the abscess to burr hole drainage of the pus. Stereotactic assistance has recently been employed in the management of deep-seated brain abscess. Improved surgical techniques and the introduction of a range of antibiotics have resulted in a significantly improved outcome in such cases.^2-4 An unusual case of spontaneous evacuation of the cerebellar abscess is reported.

A 10-year-old girl had a history of middle ear infection in the right ear since childhood. The pus discharge from the ear continued intermittently over the years. She had severe occipital headache, recurrent vomiting, severe ataxia and altered sensorium for 2 days. She was drowsy and had marked papilledema. There were right cerebellar signs. CT scan showed a right cerebellar abscess with mild hydrocephalus. While she was being prepared for surgery, the patient noticed egress of a large amount of pus through the right ear. She had remarkable relief from all her symptoms.

Repeat CT scan showed collapse of abscess cavity. The middle ear cavity showed haziness and an air bubble. An otolaryngologist did the further management of the patient.

Brain abscesses can occur at any age but these are especially common in the first decade of life. ^1,2,4 Forty per cent of brain abscesses occur from direct spread of infection from the paranasal sinuses, middle ear or mastoid sinus.³

Spontaneous drainage or evacuation of cerebellar abscess from the ear was an unusual feature and has not been reported before. Raised intracranial pressure, persistence of a fistula connecting the cerebellar abscess with the middle ear cavity and perforation in the tympanic membrane could have assisted the spontaneous abscess drainage.

REFERENCES

1, Bhatia R, Tandon PN, Banerji AK. Brain abscess _ an analysis of 55 cases. Int Surg 1973;58:565-8.
2. Courville CB. L Subdural empyema secondary to purulent frontal sinusitis. A clinicopathologic study of forty-two cases verified at autospy. Arch Otolaryngol 1994;39:211.
3. Farmer TW, Wise GR. Subdural empyema in infants, children and adults. Neurology 1973;23:254.
4. Kaufman DM, Miller MH, Steigbigel NH. Subdural empyema. Analysis of 17 recent cases and review of the literature. Medicine 1975;54:485.

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