[Recurrent cerebellar abscess secondary to middle ear cholesteatoma: case report]

We report a case of recurrent cerebellar abscess secondary to middle ear cholesteatoma. A 57-year-old man was admitted to our hospital because of symptoms of headache and nausea in August, 1992. Brain CT scans revealed acute hydrocephalus complicated by a cerebellar abscess. The patient was discharged without any neurological deterioration after systemic antibiotics combined with intrathecal aminoglucoside administration via ventricular drainage. Mannitol was also administrated for 7 days immediately after the patient's admission. The clinical course was uneventful for 8 years afterwards. Follow-up MR images revealed no signs of recurrence. Unfortunately, the patient suffered a recurrence of cerebellar abscess in October, 2000. His condition continued to deteriorate in spite of being treated by systemic antibiototics. MR images and CT scans targeting a portion of his middle ear revealed extensive pus-coated mastoiditis and middle ear cholesteatoma. We thus performed radical mastoidectomy including removal of the middle ear cholesteatoma. After the operation, the cerebellar abscess was ameliorated. He has been free from recurrence for 2 years, so far. Early diagnosis and prompt intervention are necessary for reducing mortality and morbidity rates due to otogenic brain abscess. Recognizing middle ear cholesteatoma as one of the major causes of neurological entities in the cerebellopontine angle portion, accurate otological examination and prompt treatment can possibly bring about a better prognosis.