Intracranial spread of organism may occur via the middle ear by thrombophlebitis or by penetration of the dura of the middle or posterior cranial fossae.
Meningitis
Clinical features:
Presents as headache, neck stiffness and photophobia. Lumbar puncture confirms the diagnosis. Pneumococcus and Haemophilus influenzae are common pathogens.
Management:
Treatment is by intravenous antibiotics followed by mastoidectomy once the meningitis has revolved.
Venous sinus thrombosis
Follows spread of middle ear and mastoid infection through the bone over the sigmoid sinus.
Clinical features:
Presents as headache, pyrexia and rigors. Extension of thrombus to the superior sagittal sinus leads to CSF outflow obstruction: otitic hydrocephalus.
Management:
Treatment is by intravenous antibiotics and mastoidectomy, during which infected thrombus may need to be removed from the sinus lumen.
Intracranial abscess
Extradural, subdural and cerebral abscesses occur. Infection spreads into the middle and posterior cranial fossae leading to temporal lobe and cerebellar abscesses respectively. Diagnosis by CT scan and treatment by neurosurgical drainage.
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