Otogenic Cerebellar Abscess - Case Report

儘管抗生素問世以後，中耳感染造成之顱內併發症已減少許多，但中耳感染仍然是腦膿瘍最常見之致病因子。我們報告一例耳因性小腦膿瘍之病例。這名53歲男性病患是以突發性眩暈、頭痛併噁心、嘔吐及雙側中耳炎耳漏加劇表現。當時病人的腦部顯影劑電腦斷層攝影並無任何異常發現，眼振圖檢查卻已經出現向下垂直眼振。一個月後病人病況惡化，出現意識障礙、行動失調、頸部僵硬等症狀。重覆電腦斷層攝影檢查發現小腦蚓部及左半葉交界處之小腦膿瘍並伴有阻塞性水腦症。病人接受神經外科醫師執行之小腦膿瘍引流手術，手術後6週之靜脈抗生素治療，並以系列電腦斷層攝影追蹤。6週後，膿瘍完全消失，病人情況良好，並未留下任何異常神經學症狀。耳因性小腦膿瘍之致病機轉，是由逆行性血栓靜脈炎侵犯小腦，引起廣泛小腦組織炎，之後炎症反應集中，形成膿瘍。本病例發病當初的電腦斷層並無異樣，眼振圖檢查出現中樞性異常眼振，很可能即為膿瘍形成之初期變化。因此，電腦斷層攝影檢查並不能完全排除耳因性顱內併發症之可能。臨床上應保持警覺，追蹤病況，並以系列電腦斷層攝影或核磁共振檢查，以期早期診斷，使此一致命併發症之發生降為最低。

關鍵字

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並列摘要

Although uncommon in the modern era of antimicrobial therapy, potentially lethal intracranial complications of acute and chronic otitis media still occur. We encountered a 53-year-old man with bilateral chronic otitis media who developed an abscess in the junction of the vermis and right hemisphere of the cerebellum. The patient presented with vertigo, intractable headache, exacerbation of otorrhea and down-beat nystagmus on electronystag-mography (ENG). However, the initial brain computed tomographic (CT) scan was negative. Unfortunately, the patient deteriorated to a state of drowsy consciousness in one month and the follow-up CT scan revealed a cerebellar abscess with impending herniation. Drainage of the abscess was performed immediately by a neurosurgeon. After the operation, the patient received intravenous antibiotic treatment for 6 weeks and was followed with serial CT scans weekly until the abscess resolved completely. We concluded that the diagnosis of otogenic intracranial complications should be based on a high index of suspicion and if necessary, repeated CT scans or magnetic resonance imaging (MRI) should be performed.

並列關鍵字

chronic otitis media ； cerebellar abscess

國際替代計量

Otogenic Cerebellar Abscess - Case Report

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