[A quiet clinical course in an otogenic brain abscess]

The occurrence of otogenic intracranial complications has been significantly diminished by introduction of antibiotic therapy, improved diagnostic methods and surgical treatment of chronic otitis. Meningitis is still the most frequent otogenic intracranial complication, otogenic brain abscesses are following, while other complications occur rarely (1,2,3). Otogenic meningitis and brain abscesses are often associated, which makes the on time diagnosis of each complication harder. Mortality from otogenic brain abscesses is still relatively high, despite diagnostic and therapeutic achievements (4.5).

The aim of this study is to present a patient with brain abscess, which arose quietly, as a consequence of chronic suppurative otitis and to point at possibilities of diagnostics and treatment of this complication. The diagnosis of brain abscess by clinical methods of examination is not always reliable. It is often accompanied by most severe form of meningitis, so that neurological examination, in most cases, reveals only signs of meningitis. In our patient, the abscess has been detected by computerized tomography, in its late stage, when it already had completely formed a capsule and had shown clinically manifesting focal signs. This case is interesting because of quiet and unperceived evolution of brain abscess. In the active phase of chronic suppurative otitis, the patient was receiving antibiotic therapy, which has most likely hidden the early symptoms of evolution of intracranial infections. The appearance of signs of focal intracranial infection (photophobia) required applying computerized tomography revealing brain abscess, which was clearly bounded, with a developed capsule, pointing at its late stage (about two months). These findings lead to a conclusion that an otologist should always keep in mind and check whether there is an intracranial infection in cases of active phase chronic otitis.