Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
MAY 2012
Next Case of the Month coming June 5...
Otitic Hydrocephalus
- Intracranial complication of chronic suppurative otitis media.
- More commonly seen in the pre-antibiotic era. Uncommon now.
- Usually seen to occur in the first decade of life. Uncommon in the adult population.
- Presenting features include vomiting, headaches, blurred vision, papilledema, and a picket fence fever curve. Elevated opening pressure during LP with normal CSF composition and radiographic evidence of sinus thrombosis is the mainstay of diagnosis.
- Pathogenesis: Generally accepted that OH is a syndrome of reduced CSF absorption in the setting of sinus thrombosis in a paitent with suppurative otitis media.
- Most common bacteria: S. pneumoniae, S. pyogenes, H. influenzae
- Key Diagnostic Features: Hydrocephalus, opacified mastoid air cells and tympanic cavity, and ipsilateral sinus thrombosis. Also, an abscess can sometimes be seen. Signs of increased intracranial pressure including prominent subarachnoid space surrounding the optic nerves, and empty sella.
- Rx: IV Antibiotics, surgical intervention. In addition, Rx also includes steroids, mannitol, furosemide, and acetazolamide in the acute setting, to reduce intracranial pressure. LP and VP shunts are sometimes performed, but do carry a risk of herniation. Additionally, optic nerve sheath fenestration can be considered to reduce risk of blindness.
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