Cerebral artery infarction presented as an unusual complication of acute middle otitis
Main Article Content
Keywords
Cerebrovascular disorders, Cerebral infarction, Otitis media, Middle cerebral artery
Abstract
Background: acute otitis media is a frequent disease in the pediatric age. About 2 % of all cases develop intracranial complications such as meningitis. The cerebral infarction originates meningitis and usually occurs in the venous system. The presence of a cerebral artery infarction secondary to acute otitis media is a rare cause described in the literature.
Clinical case: a girl of 12 months who presented a febrile syndrome due to acute otitis media and mental confusion. On physical examination, appeared sleepy, anisocoria, mydriasis in the right eye and left hemiparesis. The computed tomography examination showed extensive cerebral artery infarction. The patient’s parents refused the proposed surgical treatment and the girl died 48 hours later.
Conclusions: regardless of the current technological advances, the clinical prognosis of cerebral infarction associated with acute otitis media is bad. The focused neurological signs and progressive clinical deterioration should raise suspicion that antimicrobial therapy is not effective.
References
Mendoza PL, Conway EE jr. Cerebrovascular events in pediatric patients. Pediatr Ann. 1998;27(10):665-74.
Prada DM, Espinosa E, Rangel O. Enfermedad cerebrovascular en niños: enfoque diagnóstico y guías de manejo. Acta Neurol Colomb. 2004;20(1):23-38
Friedman EM, McGill TJ, Healy GB. Central nervous system complications associated with acute otitis media in children. Laryngoscope. 1990;100(2 Pt 1): 149-51.
Miura MS, Krumennauer RC, Lubianca JF. Intracranial complications of chronic suppurative otitis media in children. Braz J Otorhinolaryngol. 2005;71(5):639-43. Texto libre en http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992005000500015&lng=en&nrm=iso&tlng=en
Migirov L, Duvdevani S, Kronenberg J. Otogenic intracranial complications: a review of 28 cases. Acta Otolaryngol. 2005;125(8):819-22.
American Academy of Pediatrics. Subcommittee of management of acute otitis media. Diagnosis and management of acute otitis media. Pediatrics. 2004; 113(5):1451-65. Texto libre en http://pediatrics.aappublications.org/content/113/5/1451.full
Rosenblüt A, Santolaya ME, González P, et al. Bacterial and viral etiology of acute otitis media in Chilean children. Pediatr Infect Dis J. 2001;20(5):501-7.
Bluestone CD, Stephenson JS, Martín LM. Ten years review of otitis media pathogens. Pediatr Infect Dis J. 1992;11(8 Suppl):S7-11.
Paparella M, Shumrick DA. Complicaciones de las otitis media supurativa. En: Paparella M, Gapany M, Keefe MA, editores. Otorrinolaringología. Madrid, España: Panamericana; 1994. p. 1623-49.
Oestreicher-Kedem Y, Ben-Sira L, Grissaru G, et al. Arterial brain infarction in complicated acute otitis media. Int J Pediatr Otothinolaryngol. 2007;71(4): 659-63.
Ortiz P, González E, Pedregal MA, et al. Revisión actual de los abscesos cerebrales como complicación de los procesos infecciosos. Acta Otorrinolaringol Esp. 1984; 35(5):393-406.