Vol.97 No.6 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 97 No. 6 June 2004
A Case of Mastoiditis Causing Meningitis
with Consciousness Disturbance
Susumu Baba, Akihiro Kaneko, Seiko Oda, Mototane Komeda,
Hiromichi Kuriyama, Nobuhiko Waka and Toshio Yamashita
(Kansai Medical University)
We report a case in which mastoiditis caused meningitis with consciousness disturbance due to acute otitis media in patient with cerebral arteriovenous malformation (following AVM surgery), occurring 14 years after surgery.
The patient was a 32-year-old, female. X-ray and CT scan of the mastoid showed clouding and a fusion image involving part of the mastoid cells on the affected side. A burr hole showed the presence of mastoid cells, and thus it was thought to be the route of infection.
The patient underwent mastoidectomy. A bone defect was recognized in the middle cranial fossa, but there was no dura mater defect or leakage of cerebrospinal fluid observed. However, leakage of cerebrospinal fluid did later develop 12 days after the initial surgery. Craniotomy was performed over a wider area than that during the previous AVM surgery.
An increase in the size of the cerebrospinal fluid fistula and in the degree of granulation was recognized in the osteotomy region and in the dura mater that had been incised during the previous AVM surgery. This case supports the findings of previous reports which indicated that factors such as inner ear deformity or duraplasty in an area behind acute otitis media may be related to intracranial otogenic complications. Craniotomy for AVM may be a potential route of infection for intracranial otogenic complications. The surgical method should thus be selected and managed carefully in order to avoid postoperative onset of such infections.
Key words : acute mastoiditis, intracranial otogenic complications, masked mastoiditis, factors of anatomy, route of infection