A Pathophysiology of a 28 yr.

old man with Brain Abscess related to chronic otitis media

Predisposing factors: History of trauma High virulence ofrganism Age Gender (male) Normal patency of ear is blocked Precipitating Factors: Work Socioeconomic factors

Air trapped is resorbed

MICROBIOLGY Epithelial cells-Moderate Leukocytes-Few Gram (+) cocci in pairsfew Gram (+) bacilli- plenty Gram (-) bacilli- few

Negative pressure in the cavity

Accumulation of fluid in the middle ear

Ceftriaxone 2gms IVTT q 12

Pathogens gain access to ear

ANST(-)

Pathogen multiply

Effusion accumulates behind tympanic membrane

Local infection of the middle ear

Vasodilation of arterioles

Bulging of the tympanic membrane

Formation of whitish plaques and nodular deposits on submucosal surface

Saclike mass formation in the epithelial lining of tympanic membrane

Accumulation of WBC (neutrophils, macrophages)

Eustachian tube attempts To close

Perforation of the tympanic membrane

Shedding and desquamation of plaques and deposits

Adherence of Saclike mass

Neutrophils engulf & kill the offending organism

Lesions expands and erodes surrounding surfaces

Conductive hearing loss

Failure of immune response in tissues

Ear crackling sounds

Ear blockage
Erosion involves temporal lobe Purulent material drains from eustachian tube into the tympanic membrane Radical mastoidectomy with type IV tympanoplasty

Systemic inflammatory response

set point for body temperature

Inflamed mastoid and air entrapment

FEVER Presence of foul smelling odor Effusion remains behind tympanic membrane Necrosis of mastoid process and destruction of bony structures

Erythema & edema formation

Recurrent otitis media

Infection spreads Sensatio n of fulness otalgia Drainage of pus

CT SCAN -There is 5.0x5.8x71 cms cystic mass with thick enhancing walls at the left temporo-parietal lobe with compression of the left lateral and third ventricle, compression of the sulci and

PND otc Drugs 3 drops TID @Left Ear

Infected brain cells collect in an area in the brain

Lethargy headache

Celecoxib200mg 1Cap BID

Necrotic tissue formation

vomiting

Purulent abscess

Brain swells

irritability

Granulated tissue

ICP

Dilation of one pupil

Blocks the blood vessels of brains

Obstructive to drainage Pressure on delicate brain tissue

HEMATOLOGY WBC-13 neutrophils-86.5

Encapsulated abscess
Transient neurodisorders

temporal

parietal

Homonymous quadrantanopia

Impaired position sense

Wernickes aphasia Mild contralateral facial muscle weakness

Homonymous hemianopia Impaired optokinetic nystagmus

Blood transfusion
Dexamethasone 2mg 1tabq12hours x2days
BURR HOLE CRANIOTOMY, left temporoparietal, drainage of abscess Blood loss due to surgery

Post-op wound at left temporoparietal area

Ketorolac20mg IV q 8Hours x 3 days

With 02 inhalation @ 2L/min

Metronidazole 500mg IVTT q6hours pain Nasogastric tube at left nostril PNSS 1L @ 30gtts /min Ranitidine50mg IV q8Hours

Tramadol50mg IV q6h
Foley bag cathter in place

Celecoxib200mg 1Cap BID infection recovery

URINALYSIS Leukocytes- Trace Pus Cells-(1-3) RBC 0-3 Amorphorus Urates- Few

death

LEGEND: PREDISPOSING FACTORS SIGNS AND SYMPTOMS ACTUAL PATHOPHYSIOLOGY

PRECIPITATING FACTORS LAB RESULTS MEDS

MEDICAL INTERVENTIONS

POSSIBLE COMPLICATIONS

SURGICAL PROCEDURES

DIsEASE PROCESS