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TheAmericanJournalofSurgery

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Pediatric otogenic intracranial abscesses

2010, Otolaryngology - Head and Neck Surgery

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Volume42,Issue1,OctoberDecember1938,Pages131141

Intracranial spread of chronic middle ear

2010, American Journal of Otolaryngology

Originalarticle

Thediagnosisandtreatmentofotogenicmeningitis
SamuelJ.Kopetzky,M.D.,F.A.C.S.(ProfessorofOtology)

Rapid evolution of acute mastoiditis: Thr

2004, American Journal of Otolaryngology

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doi:10.1016/S00029610(38)911602

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Abstract
1.

1.Inotogenicmeningitis,theparticularbacteriainvadingthecentralnervoussystem
playinthemselvesarelativelysmallrlethetissuereactionsandtheclinicalsigns
arealmostsimilar,irrespectiveofthenatureandkindofinvadingmicroorganism.

2.

2.Clinicalevidencestressesthefactthatthesymptomatologyisdivisibleintotwo
groupsofclinicalsigns:thoseduetoincreasedintracranialpressure,andthosedue
totoxicity,includingtheterminalsepsisfrombacterialactivity.Wherethe
predominatingsymptomsarethoseofpressure,ifthiscanberelieved,curewillnot
necessarilyfollowunlesstheotherfactorsincidentaltothelesionhavebeen
mastered.Iftheintracranialpressureisabated,timeisgainedtocarryonmeasures
tocombattheotherfactors.Iftheintracranialpressureremainshighandmounts,
thendeathintervenesbeforetheotherfactorsinthecasecanbehandled.

3.

3.Drainageofthecentralnervoussystemdoesnotanswertheproblempresentedin
meningitis.Theproblemismoreinkeepingthebraintissuealivetooutlastthe
infection.Theimportantsteptoaccomplishthisistokeepthecerebrospinalfluid
circulating.Anyprocedureoranytechniquewhichstopsthiscirculationdefeatsone
oftheobjectsinview.Braincellsnaturallyfunctionbest,andtheirbyproductsof
cerebralcellmetabolismaremosteasilyneutralized,whentheyarekeptbathedina
cerebrospinalfluid,thechemistryofwhichisasnearnormalaspossible.Thedeposit
ofplasticexudate,whichimpedescerebrospinalcirculation,istobelessenedtothe
greatestpossibledegree.Thisisbestaccomplishedbytheadministrationofsmall
wholeblooddirecttransfusions,whicharebegunasearlyaspossibleinthecourse
ofthediseaseandcontinueduntilallmeningealsymptomshavedisappeared.

4.

4.Chemotherapy,intheformofsulfanilamide,hasdemonstrateddistinctvalue.It
maybegivenbymouth,injectedintramuscularly,orinacombinationofbothmeans.
Duringitsadministration,repeatedtestsformethemoglobinshouldbetaken.
Combinedwiththebloodtransfusions,thedangersfromthereactionstothedrugare
lessened.

5.

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5.Noevidenceisasyetathandthatmedicaltreatmentalonesufficestogivea
reasonableassuranceofobtainingconsecutiverecoveries.Itisthereforeabsolutely
necessarythateverypossiblebonefocusbethoroughlyremovedassoonasits
presenceisdiagnosed.Additionally,thebreakingofthecontiguityofstructureofthe
skeletalduralveinsafrequentrouteformeningealinvasiongivesanotherfactor
towardobtainingrecovery.Indiagnosis,theclinicalpicturealoneisinsufficientto
furnishtheclinicianwithspecificdiagnosticdata.Ingeneralterms,itmaysufficeto
establishaclinicaldiagnosisofotogenicmeningitis,butsinceanexactdetermination
ofthephasewhichthegivencasepresentsishighlydesirablesoastoinstitute
intelligentremedialtherapydatawhichfurnishthebasisforthisdetermination
mustbesought.Cluesaretobefoundinrepeatedspinaltapexaminations,andin
comparisonsofthefluidcontentswiththoseofthecirculatingblood.Influid
examination,itsphysicalproperties,thepressureunderwhichitisobtained,its
cytology,itsbacteriology,andlastlyitschemistryareexceedinglyimportant.
6.

6.Withthesenewerconceptionsofotogenicmeningitis,morerecoveriesarebeing
reported,andwemeetmeningealinfectionswithmoreconfidencebecauseweare
betterabletocombatthem.Withthishopefulnoteonthefutureadditional
developmentsintherapy,letme,forthepresent,leavetheproblemspresentedby
otogenicmeningitis.

Copyright1938PublishedbyElsevierInc.
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