Otitis Media Leads to Brain Abscess Presenting as Stroke

By Mikhail Elfond, DO; Esi Quayson, MD; & Joseph V.M. Kelly, MD, MBA A 65-year-old man presented to the ED via EMS with symptoms of stroke. The paramedics stated his right-sided weakness and speech difficulty started 40 minutes prior to presentation in the ED. En route to the hospital, paramedics observed four episodes of facial twitching.       Vitals signs were significant for a rectal temperature of 100.2°F and a fingerstick blood sugar of 220 mg/dL. History of present illness was significant for a diagnosis of left otitis media treated with Augmentin and Vicodin at an urgent care center one day prior to presentation. Past medical history included hypertension, hypercholesterolemia, and diet-controlled borderline diabetes mellitus.   He appeared confused and did not follow commands. He had a right lateral gaze, a right pronator drift, and global aphasia. Left tympanic membrane was perforated with purulent discharge. No mastoid tenderness or overlying skin changes were noted.   A head CT scan without contrast was performed, and revealed an ill-defined low attenuation lesion within the posterior left temporal lobe with associated pneumocephalus. Given ipsilateral opacification of the mastoid air cell and middle ear, findings were concerning for otomastoiditis complicated by intracerebral abscess. A follow-up maxillofacial CT scan with contrast showed thinning of the overlying roof of the temporal bone with dehiscence at multiple...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research