Enterococcal Otogenic Brain Abscess

Park, See Young; Min, Jung Ha; Ryu, Ji Woon; Ko, Young Seung

Abstract

Despite advances in imaging and antibiotic treatment, brain abscess is still encountered occasionally and is one of the most significant life-threatening complications of otologic disease. Nowadays, mortality rates of up to 10 percent have been reported. Brain abscesses are developed up to 0.5 percent of cases of acute otitis media and 3 percent of cases of chronic suppurative otitis media. In this case, underlying middle ear pathology showed chronic otitis media with cholesteatoma. Successful management of otogenic brain abscess still includes medical and surgical treatment. Initial surgical treatment of abscess is very controversial today. Some authors prefer the surgical excision of brain abscess prior to the management of temporal bone, yet other authors prefer the surgery of temporal bone prior to the management of brain abscess. Although an enterococcus is a significant cause of human infections outside of the central nervous system but, enterococcal infections involving the central nervous system are uncommon clinical entities. Because of the relatively small number of individuals who develop brain abscess or meningitis due to an enterococcus, an appropriate therapy has not been well defined. We report a case of enterococcal otogenic brain abscess which was treated successfully using antibiotics, immediate radical mastoidectomy and later stereotactic abscess drainage with a review of literatures.