Otitis Media and Its Intracranial Complications: A Delicate Scenario

Intracranial complications of otitis media are rare but pose a significant risk of morbidity and mortality. We report a case of a 27-year-old man with cognitive impairment who presented with fever, right-sided otalgia, otorrhea, and vomiting for three days. His neurological examination was unremarkable, and a brain computed tomography (CT) revealed right-sided otomastoiditis without intraparenchymal lesions. Despite intravenous antibiotic therapy, the patient's condition deteriorated within 24 hours, with worsening fever, fluctuating consciousness, and signs of meningeal irritation. A follow-up computed tomography revealed tympanic erosion, right temporal cerebritis, and edema. The patient underwent tympanomastoidectomy; however, seven days later, a brain magnetic resonance imaging (MRI) showed a brain abscess and subdural empyema. Surgical drainage was performed, and the patient completed a 13-week course of antimicrobial therapy, achieving a favorable clinical and imaging outcome. This case highlights the importance of early diagnosis and intervention in improving the prognosis of patients with intracranial complications of otitis media.