LII Rhinogenous Intracranial Complications in the Antibiotic Era

On the Management of Oto-Rhinogenic Intracranial Infections

“…Cerebral oedema may follow operations for brain abscess and for tumours (Jefferson, 1943;Cairns, 1939;Northfield, 1942;Wood, 1952); it may follow well performed aspiration of an abscess (e.g. also Skolnik et al, 1953) and may come on astonishingly rapidly; anoxia may be a potent factor in its production (Sadova et al, 1953;Jefferson, 1943;others) Because of it aphasia, hemianopia, paresis may be temporarily worse after operation. It requires prompt treatment by dehydration measures or, failing these, surgical decompression; lumbar punctures or ventricular drainage are not so satisfactory; adequate oxygenation of the patient is essential.…”

“…It is frequently impossible to determine whether the lesion is an encapsulated abscess or an area of suppurative encephalitis until it is explored (also McKenzie (1948), who urges diagnostic exploration in such cases). Sometimes a well-defined capsule is not found with a history suggesting intracerebral suppuration for four to five weeks (also Skolnik et al, 1953). Sometimes a capsule never develops (also Davis, 1953); in many otogenic brain abscesses causing such grave illness as to demand immediate surgery no capsule is found (e.g.…”

“…The dura may look normal (e.g. also Skolnik et al, 1953), or appear white because of the pus under it. Once the dura has been incised, pus wells out but is soon prevented from continuing to do so by the brain bulging into the opening.…”