Complications and Prognosis
Cranial nerve neuropathy is the most common non iatrogenic complication in MEO and SBO. Pseudomonas – aeroginosa produces destructive enzymes and exotoxins that promote tissue necrosis and reversible neurotoxicity 32. Other than facial palsy, the Jugular foramen syndrome affecting 9th, 10th and 11th Cranial nerves compromising phonation, swallowing and protection of the tracheobronchial tree. Other cranial nerves which may be affected are 3rd, 5th and 6th. In untreated or advanced cases death results due to meningitis, cerebritis, cerebral abscess, jugular formamen syndrome, pulmonary aspiration and pneumonia, vascular thrombosis, CVA or subarachanoid hemorrhage. The mortality rate is high with multiple cranial neuropathies despite optimal antimicrobial therapy. However recent reports with appropriate antibiotic therapy shows cure rates to be 80% – 100%. Use of hyperbaric O2 as an adjuvant therapy has also further reduced the mortality rate.
SUMMARY AND CONCLUSION
SBO is an agressive, invasive, indolent infection with potentially significant morbidity and mortality. The most common form of SBO is MEO typically seen in elderly diabetics although infections may be from other neurosurgical and cranial base sources or procedures. The diagnosis is based on detail history, clinical evaluation, culture, biopsy, blood sugar, ESR and imaging studies. Intravenous antipseudomonal antibiotic therapy, surgical debridement of granulation tissue, bony sequestration and devitalised tissue from EAC can control and cure the disease effectively. Treatment for recalcitrant infections can be supplemented with adjuvant hyperbaric oxygen (HBO) therapy. The course of antibiotic therapy varies from a short 2 to 3 weeks for MEO in children to 6 months for SBO in adults. The duration of therapy is determined by number of factors including symptomatic and clinical response and demonstration of the resolution of inflammation by monitoring treatment with sequential CT, gallium scan and ESR. The overall morbidity and mortality have significantly declined with current methods of diagnosis and treatment during the past three decades when MEO was first described.
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