Answer for CoW 25 June 2017
Fungus Cerebri
Findings
Evidence of herniation of right temporal cortex through a defect in right Tegmen Tympani measuring 9mm into right external auditory canal with medial displacement of ossicles. Fluid intensity noted involving right mastoid air cells. Features suggestive of – fungus cerebri – herniation of right temporal cortex through a defect in Tegmen Tympani into external auditory canal with medial displacement of ossicles.
Discussion
Fungus cerebri is protrusion of brain and dura out of the cranial cavity into the mastoid and middle ear. The predisposing factors include: prior ear surgery such as mastoidectomy (radical or modified radical), meningitis, cholesteatoma and active chronic otitis media. Defect in the tegmen tympani and or tegmen antri are the most common sites of occurrence. Herniations are classified as pedenculated or sessile. They are associated with infection, CSF leak, and neurological complications. They are also associated with otological problems such as hearing loss, and trapped squamous epithelium. The commonly herniated part is the temporal lobe, but cerebellar herniation are also reported. The brain protrudes through the dural opening into the mastoid cavity and may present at the scalp incision. The herniation may be accompanied by a leakage of cerebrospinal fluid. Management consists of wide surgical exposure, amputation of necrotic, herniated brain tissue, watertight dural closure, and closure in layers of the overlying soft tissues. The underlying cause of the increased intracranial pressure needs to be removed
Findings
Evidence of herniation of right temporal cortex through a defect in right Tegmen Tympani measuring 9mm into right external auditory canal with medial displacement of ossicles. Fluid intensity noted involving right mastoid air cells. Features suggestive of – fungus cerebri – herniation of right temporal cortex through a defect in Tegmen Tympani into external auditory canal with medial displacement of ossicles.
Discussion
Fungus cerebri is protrusion of brain and dura out of the cranial cavity into the mastoid and middle ear. The predisposing factors include: prior ear surgery such as mastoidectomy (radical or modified radical), meningitis, cholesteatoma and active chronic otitis media. Defect in the tegmen tympani and or tegmen antri are the most common sites of occurrence. Herniations are classified as pedenculated or sessile. They are associated with infection, CSF leak, and neurological complications. They are also associated with otological problems such as hearing loss, and trapped squamous epithelium. The commonly herniated part is the temporal lobe, but cerebellar herniation are also reported. The brain protrudes through the dural opening into the mastoid cavity and may present at the scalp incision. The herniation may be accompanied by a leakage of cerebrospinal fluid. Management consists of wide surgical exposure, amputation of necrotic, herniated brain tissue, watertight dural closure, and closure in layers of the overlying soft tissues. The underlying cause of the increased intracranial pressure needs to be removed
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!