Management of a Complex Case of a Recurrent Paraganglioma

Paragangliomas are rare, slow-growing, hypervascular, catecholamine-secreting neuroendocrine tumors arising from the paraganglia. Paragangliomas are rarely found in the head and neck and are typically benign, presenting as a painless, slow-growing mass. Surgical extirpation in combination with long-term surveillance has been long regarded as the standard of care; however, the advances in imaging, radiation therapy, and embolization techniques have improved diagnostic and therapeutic modalities. We present a case of an 87-year-old female who had previously undergone resection of a paraganglioma in 1998, with no evidence of disease in 2002. Eighteen years later, the patient presented to the clinic with otogenic complaints. Imaging showed an expansive mass from the jugular foramen with bone destruction and opacification within the ear canal. The patient opted for observation. The patient eventually presented to the emergency room with neurologic manifestations. Imaging showed a cerebellar abscess prompting emergency drainage. Intraoperative cultures grew Prevotella loescheii and S. intermedius, and the patient was started on 6 weeks of IV antibiotic therapy. Debulking of the paraganglioma was performed followed several months by mastoid and ear canal obliteration; however, the patient experienced complications, including dehiscence of the external auditory canal and Clostridium difficile infection. The patient was eventually treated successfully, marked by a reduction in complaints, a return to baseline activities, and imaging showing no increase in tumor size.

Otogenic Brain Abscess: Judicious Management in a Case of Chronic Suppurative Otitis Media

Intracranial consequences from chronic otitis media can be dreadful. Meningitis is the most frequent complication followed by a cerebral abscess. In this pre-antibiotic era, otogenic brain abscess is rare, but it poses one of the life-threatening complications of otitis media. In recent years, brain abscess was noticed almost only in patients of chronic Otitis media with cholesteatoma. A case of a 36-year-old non-diabetic male patient with an otogenic cerebellar abscess, who presented with no cerebellar signs and unique intraoperative ossicular chain status was successfully managed by a combined approach of otolaryngology and neurosurgery, is presented in this report.

Mucormycosis creeping along the nerves in an immunocompetent individual

Mucormycosis is a rare opportunistic fungal infection, often life-threatening. We report an unusual case of rhinocerebral mucormycosis in an immunocompetent patient. A 23-year-old male presented with headache, speech disturbance and hearing difficulty for 4 weeks. Magnetic resonance imaging (MRI) revealed right cerebellar abscess and enhancing soft tissue in the nasal cavity, extending to cranial and infratemporal fossae. Computed tomography (CT) revealed the widening of foramen rotundum and sclerosis involving the sphenoid and ethmoid sinuses. MR Spectroscopy revealed multiple peaks between 3.6 and 3.8 parts per million (ppm) which could represent trehalose. Nasal mucosa scrapings confirmed mucormycosis. Suspicion of a fungal infection needs to be considered even in the absence of immunocompromised status.

A Rare Complication of Chronic Otitis Media: Cerebellar Abscess

Chronic otitis media (COM) and its associated complications are currently less common because of the popularity of imaging modalities such as computed tomography and magnetic resonance imaging and the increased use of antibiotics. Patients can be treated without any complications owing to early diagnosis. Despite all these new developments and opportunities, complications of autogenous cerebellar abscess may develop and be fatal. In this case report, we present our own clinical experience regarding a patient with cerebellar abscess as a complication of COM.