Pediatric Masked Mastoiditis Associated with Multiple Intracranial Complications

Abstract

Masked mastoiditis is a distinct form of mastoiditis with little or no symptomatology, characterized by its potential to generate severe otogenic complications. Therefore, suspected masked mastoiditis should be diagnosed and treated without delay. This study reports a rare case of masked mastoiditis, manifested by multiple intracranial complications in an immunocompetent girl. The child exhibited headache and neurological symptomatology. Imaging studies revealed an epidural and a large cerebellar abscess and the patient was immediately treated with a triple antibiotic therapy. Mastoid surgery and drainage of the epidural abscess took place after the stabilization of the patient's neurologic status, on the 3rd hospitalization day. The cerebellar abscess was treated by craniectomy and ultrasound-guided needle aspiration in the 3rd week of hospitalization. The girl was finally discharged in excellent condition. Two years later, she is still in good health, without otological or neurological sequelae. Masked mastoiditis is an insidious disease which requires increased clinical awareness and adequate imaging. Should clinical and/or radiological findings be positive, mastoidectomy must follow in order to prevent severe otogenic complications that can be triggered by masked mastoiditis.

Silent mastoiditis: Two case reports

“…Mastoid kavite içerisinde inflamatuar reaksiyon, granülasyon dokusu, osteit ve ilerleyen dönemde osteolizis gibi histolojik değişikliler devam etmektedir [3,6]. Sonuç olarak patogenez oluşum mekanizmasında yetersiz tedavi edilen AOM sonucu mukozal ödem ve granülasyon dokusu oluşumuna inanılmaktadır [4]. Çalışmamızdaki her iki olgunun da daha önceden geçirilmiş AOM öyküsü mevcuttur.…”

“…Sessiz mastoidit; mastoid hücrelerin kemik yapılarında ve mukozal tabakalarındaki subklinik enflamatuar süreci tanımlamaktadır [3]. Sessiz mastoiditte orta kulak boşluğu sağlıklıdır [4]. Literatürde latent mastoidit ve maskelenmiş mastoidit olarak da adlandırılmaktadır [3,5].…”

“…Literatürde latent mastoidit ve maskelenmiş mastoidit olarak da adlandırılmaktadır [3,5]. Sessiz mastoidit ciddi otojenik komplikasyonlar oluşturma potansiyeli nedeniyle erken tanı konulmalı ve geciktirilmeden tedavi edilmelidir [4].…”

Hoofbeats, Zebras, and a Child with Vomiting

“…Conventional and venous magnetic resonance imaging (MRI) confirmed the diagnosis demonstrating also ipsilateral jugular vein thrombosis and epidural abscess (►Figs. [1][2][3]. After drainage of the abscess, low molecular weight heparin was administered for 2 months with complete neurological recovery.…”

“…1,2 Rarely otalgia could be lacking. 3 Although vomiting and drowsiness are common findings in acute gastroenteritis, one should also suspect intracranial hypertension.…”