Orta Kulak İltihabı Sonrası Temporal Apse Gelişen Hastaya Yoğun Bakımda Yaklaşım
Özet
Orta kulak iltihabına bağlı gelişen temporal apse, nadir ancak hayatı tehdit edebilen intrakraniyal komplikasyonlardan biridir. Bu bölümde, otitis media sonrası gelişen temporal apse olgusu üzerinden intrakraniyal apselerin patofizyolojisi, klinik bulguları, tanı yöntemleri, tedavi yaklaşımları ve yoğun bakım yönetimi ayrıntılı olarak ele alınmaktadır. Apse gelişim süreci erken serebritten kapsül formasyonuna kadar açıklanmakta; kafa içi basınç artışı, nörolojik defisitler, nöbetler ve bilinç değişiklikleri gibi klinik prezentasyonlar tartışılmaktadır. Tanıda manyetik rezonans görüntüleme ve bilgisayarlı tomografinin önemi vurgulanırken, mikrobiyolojik analizlerin hedefe yönelik antibiyotik tedavisindeki rolü belirtilmektedir. Güncel ESCMID kılavuzları doğrultusunda ampirik ve kültür temelli antibiyotik tedavisi, cerrahi drenaj seçenekleri ve steroid kullanımı ele alınmaktadır. Ayrıca yoğun bakım ünitesinde hemodinamik stabilizasyon, nörolojik izlem, solunum desteği ve nöbet kontrolünün multidisipliner yaklaşımla yönetilmesi gerektiği vurgulanmaktadır. Erken tanı ve uygun tedavi ile mortalite ve morbiditenin azaltılabileceği belirtilmektedir.
Temporal abscess secondary to otitis media is a rare but potentially life-threatening intracranial complication. This chapter discusses the pathophysiology, clinical presentation, diagnostic strategies, treatment options, and intensive care management of intracranial abscesses through a representative case. The evolution of abscess formation, from early cerebritis to capsule formation, is described in detail. Clinical manifestations such as increased intracranial pressure, focal neurological deficits, seizures, and altered consciousness are emphasized. The diagnostic value of magnetic resonance imaging and computed tomography is highlighted, along with the importance of microbiological analysis for targeted antimicrobial therapy. Current ESCMID guideline recommendations regarding empirical antibiotic therapy, surgical drainage techniques, and corticosteroid use are reviewed. Intensive care management principles, including hemodynamic stabilization, neurological monitoring, ventilatory support, and seizure control, are addressed within a multidisciplinary framework. Early recognition and timely intervention are critical to reducing morbidity and mortality in these patients.
Referanslar
Tandon S, Beasley N, Swift AC. Changing trends in intracranial abscesses secondary to ear and sinus disease. The Journal of Laryngology & Otology. 2009;123(3):283-8.
Huang J, Wu H, Huang H, Wu W, Wu B, Wang L. Clinical characteristics and outcome of primary brain abscess: a retrospective analysis. BMC Infectious Diseases. 2021;21(1):1245.
Evans TJ, Jawad S, Kalyal N, Nadarajah A, Amarouche M, Stapleton S, et al. Retrospective review of the epidemiology, microbiology, management and outcomes of intra-cranial abscesses at a neurosurgical tertiary referral centre, 2018–2020. Annals of Clinical Microbiology and Antimicrobials. 2022;21(1):58.
Muzumdar D, Jhawar S, Goel A. Brain abscess: An overview. International Journal of Surgery. 2011;9(2):136-44.
Wagué D, Manneh EK, Sène F, Djigo RS, Mbaye M, Thioub M. Brain abscess mimicking a brain tumor only realized during surgery: A case report in a resource strained environment. Surg Neurol Int. 2025;16:131.
Corsini Campioli C, Castillo Almeida NE, O’Horo JC, Challener D, Go JR, DeSimone DC, Sohail MR. Clinical Presentation, Management, and Outcomes of Patients With Brain Abscess due to Nocardia Species. Open Forum Infectious Diseases. 2021;8(4).
Meena DS, Kumar D, Sharma M, Malik M, Ravindra A, Santhanam N, et al. The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases. Orphanet Journal of Rare Diseases. 2023;18(1):133.
Kural C, Kırmızıgoz S, Ezgu MC, Bedir O, Kutlay M, Izci Y. Intracranial infections: lessons learned from 52 surgically treated cases. Neurosurgical Focus FOC. 2019;47(2):E10.
Laulajainen-Hongisto A, Lempinen L, Färkkilä E, Saat R, Markkola A, Leskinen K, et al. Intracranial abscesses over the last four decades; changes in aetiology, diagnostics, treatment and outcome. Infectious Diseases. 2016;48(4):310-6.
Kapsalaki EZ, Gotsis ED, Fountas KN. The role of proton magnetic resonance spectroscopy in the diagnosis and categorization of cerebral abscesses. Neurosurgical Focus FOC. 2008;24(6):E7.
Sáez-Llorens X, Nieto-Guevara J. Brain abscess. Handbook of Clinical Neurology. 2013;112:1127-34.
Brook I. Microbiology and treatment of brain abscess. Journal of Clinical Neuroscience. 2017;38:8-12.
Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, et al. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66-89.
Simjian T, Muskens IS, Lamba N, Yunusa I, Wong K, Veronneau R, et al. Dexamethasone Administration and Mortality in Patients with Brain Abscess: A Systematic Review and Meta-Analysis. World Neurosurgery. 2018;115:257-63.
Mengi E, Tümkaya F, Sağtaş E, Ardıç FN. An unusual complication of otitis media: Luc’s abscess. The Journal of International Advanced Otology. 2018;14(3):497.
Alva B, Prasad KC, Prasad SC, Pallavi S. Temporal bone osteomyelitis and temporoparietal abscess secondary to malignant otitis externa. The Journal of Laryngology & Otology. 2009;123(11):1288-91.
