Otogenic Intracranial Complication; A Case of Bacterial Meningitis

We report a case of otogenic intracranial complication. The patient was a 34-year-old female who complained of left otalgia and headache. She was hospitalized because of deterioration of her level of consciousness and high fever. On examination, her cerebrospinal fluid showed an elevated cell count. A bacterial culture of the otorrhea and cerebrospinal fluid found Streptococcus pneumoniae. A CT scan showed left acute otitis media and mastoiditis with paranasal sinusitis of the same side. This patient was successfully treated with intravenous antibiotic therapy without surgery. After she recovered, a CT scan with coronal sections showed bony defects and a thin bony wall in the left tympanic and mastoidal tegmina. This suggested that in this case the bacterial meningitis was secondary to acute otitis media and mastoiditis. When headache and high fever persist in patients with otitis media, we should suspect intracranial complications.