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Clinical Challenge
June 2016

Giant Cerebellar Lesion in a Patient With Purulent Ear Drainage

Author Affiliations
  • 1Otology and Skull Base Surgery Unit, Department of Sense Organs, “S. Maria alle Scotte” University Hospital, Siena, Italy
  • 2Audiology and Pediatric Otorhinolaryngology, Institute for Maternal and Child Health IRCCS “Burlo Garofolo,” Trieste, Italy
JAMA Otolaryngol Head Neck Surg. 2016;142(6):603-604. doi:10.1001/jamaoto.2016.0014

A woman in her 60s was evaluated in the neurosurgery intensive care unit for purulent discharge from her right ear. She had undergone an emergency craniotomy for brain decompression the day before. She was receiving intravenous antibiotics and steroids and was sedated and mechanically ventilated. Computed tomography (CT) of the temporal bone detected middle ear, mastoid, and infralabyrinthine involvement (Figure, A). Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain demonstrated meningitis and a large cerebellar lesion with rim enhancement. Moreover, diffusion-weighted imaging (DWI) images and apparent diffusion coefficient (ADC) maps were consistent with cerebellar abscess (Figure, B-D).

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