Question:medium
Patient with a history of chronic middle ear infection now presents with neurological manifestations, headache, and vomiting. CT Brain is shown (ring-enhancing lesion). What is the probable diagnosis?
Patient with a history of chronic middle ear infection now presents with neurological manifestations, headache, and vomiting. CT Brain is shown (ring-enhancing lesion). What is the probable diagnosis?
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Chronic middle ear infection spreads to the brain through the tegmen tympani, most commonly producing an abscess in an adjacent lobe.
Updated On: Jun 23, 2026
- Extradural Abscess
- Cerebral Abscess
- Temporal lobe Abscess
- Meningitis
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The Correct Option is C
Solution and Explanation
Clinical correlation: CSOM (chronic suppurative otitis media) is the most common cause of brain abscess. The infectious spread occurs via two main routes:
1. Through tegmen tympani (roof of middle ear) into the middle cranial fossa -- causes temporal lobe abscess
2. Through sinodural angle into the posterior fossa -- causes cerebellar abscess
CT Brain findings: A ring-enhancing lesion (hypodense centre + ring of enhancement on contrast CT) = brain abscess. The ring represents the abscess capsule. Surrounding hypodensity = cerebral oedema.
Why temporal lobe (not extradural, not meningitis)?
- Extradural abscess: lenticular-shaped collection outside the dura; no ring enhancement within brain parenchyma
- Meningitis: meningeal enhancement; no parenchymal ring lesion
- Temporal lobe abscess: parenchymal ring lesion in temporal lobe -- consistent with CSOM spread through tegmen tympani
Remember: CSOM intracranial complications in order of frequency: meningitis, extradural abscess, subdural abscess, temporal lobe abscess, cerebellar abscess, lateral sinus thrombophlebitis. \[\boxed{\text{Temporal Lobe Abscess}}\]
1. Through tegmen tympani (roof of middle ear) into the middle cranial fossa -- causes temporal lobe abscess
2. Through sinodural angle into the posterior fossa -- causes cerebellar abscess
CT Brain findings: A ring-enhancing lesion (hypodense centre + ring of enhancement on contrast CT) = brain abscess. The ring represents the abscess capsule. Surrounding hypodensity = cerebral oedema.
Why temporal lobe (not extradural, not meningitis)?
- Extradural abscess: lenticular-shaped collection outside the dura; no ring enhancement within brain parenchyma
- Meningitis: meningeal enhancement; no parenchymal ring lesion
- Temporal lobe abscess: parenchymal ring lesion in temporal lobe -- consistent with CSOM spread through tegmen tympani
Remember: CSOM intracranial complications in order of frequency: meningitis, extradural abscess, subdural abscess, temporal lobe abscess, cerebellar abscess, lateral sinus thrombophlebitis. \[\boxed{\text{Temporal Lobe Abscess}}\]
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