Cephalgia as the first manifestation of a life-threatening disease – differential diagnosis between otology and neurology

Introduction:

We present the case of a 29 year old young man who was presenting at the neurological emergency department twice due to cephalgia (NAS 8/10). Initially, he complained about tragal pressure-pain, hypacusis on the right ear and allodynia temporooccipitally right, about dizziness and sickness. He denied lumbal puncture and investigation via an ENT-doctor. Admission to hospital followed one week later with progredient neurological deficits and change of consciousness.

Methods:

Corporal investigation showed allodynia in the innervation area of C2, retroauricular flush, tragal pressure pain, neglect for the left side as well as reduced psychomotor activity. He had leucocytosis and an increased CRP-level. We performed cCT and MRI in order to exclude intracranial bleeding. These showed a mastoiditis, an abscess of the temporal lobe and edema with midline shift as well as a subperiostal abscess. He was subsequently presented to the ENT-department and to the department of neurosurgery.

Results:

We performed mastoidectomy with paracentesis and the neurosurgeons performed craniotomy and drainage of the temporal-lobe-abscess. The patient was treated at the intensive-care-unit and had to be revised multiple times due to persistent intracranial empyema with cerebral edema and seizures. When transferred to rehab, he still suffered from cognitive deficits and a hemiparesis left.

Conclusions:

Fulminant courses of mastoiditis with severe intracranial complication and septic courses are rare. They have to be avoided by immediate surgical therapy including mastoidectomy and adjuvant antibiotic treatment.

 

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Dr. Nora Weiss

Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie „Ot,

Doberaner Straße 137 – 139, 18055

Rostock

eMail: [e-mail]

Publikationsverlauf

Publikationsdatum:
12. Juni 2019 (online)