EARLY EXTRAVENTRICULAR DRAINAGE TO IMPROVING FUNCTIONAL OUTCOME ON ACUTE VIRAL OTOGENIC MENINGOENCEPHALITIS ACCOMPANIED WITH HYDROCEPHALUS IN YOUNG ADULT: RARE COMPLICATION OF OTITIS MEDIA- A CASE REPORT
DOI:
https://doi.org/10.31004/jkt.v6i3.49885Keywords:
Extraventicular drainage, Meningoencephalitis, Otogenic Hydrocephalus, ViralAbstract
Salah satu kemungkinan komplikasi meningensefalitis adalah hidrosefalus. Drainase ekstraventrikular secara dini membantu meningkatkan luaran klinis pasien dan dapat digunakan untuk mengevaluasi cairan serebrospinal berulang dan mengendalikan tekanan intrakranial. Seorang laki laki muda berusia 24 tahun datang ke unit gawat darurat dengan keluhan nyeri kepala yang memberat sejak 2 hari lalu. Keluhan disertai dengan leher kaku dan demam sejak 4 hari lalu. Pasien memiliki riwayat sakit telinga kiri sejak 1 minggu lalu. Pasien juga sulit fokus ketika diajak berkomunikasi dan gelisah. Pemeriksaan fisik menunjukkan tekanan darah 139/80 mmHg, nadi 91x/menit, suhu 39,5°C, dan saturasi oksigen (SpO2) 97%. Status lokalis auricula sinistra terdapat pus berwarna kuning jernih disertai nyeri tarik tragus. Pemeriksaan neurologis menunjukkan GCS 335, tanda meningeal (+), VAS 8-9. Pemeriksaan laboratorium awal menunjukkan Leukosit 21.610 sel/uL; Monosit 2.060 sel/uL; neutrofil 17.390 sel/uL, gula darah acak 193 mg/dL, HIV (-), dan DNA MTB (-). Pemeriksaan CT Scan Kepala dengan kontras menunjukkan kesan encephalitis/meningoencephalitis dengan komplikasi hydrocephalus comunican. Pasien didiagnosis dengan meningensefalitis dengan hydrocephalus dan direncakaan Extraventricular Drainage (<24 jam) serta pemeriksaan LCS. Dari hasil pemeriksaan LCS didapatkan warna jernih, Nonne apelt (+), dan pandy (+). Pasien diberikan terapi steroid, antivirus, antibitoik spektrum luas, analgesik, dan antipsikosis. Pasien menunjukkan perbaikan kondisi klinis setelah 6 hari perawatan. Kasus ini relatif jarang, terutama pada komplikasi otitis media yang menyebabkan meningoensefalitis dan hidrosefalus komunikans pada pasien dewasa muda. EVD dini dan pengobatan spesifik tampaknya meningkatkan luaran klinis.References
Bertuccio, A., Marasco, S., Longhitano, Y., Romenskaya, T., Elia, A., Mezzini, G., Vitali, M., Zanza, C., & Barbanera, A. (2023). External Ventricular Drainage: A Practical Guide for Neuro-Anesthesiologists. Clinics and practice, 13(1), 219–229. https://doi.org/10.3390/clinpract13010020
Chau, C. Y. C., Mediratta, S., McKie, M. A., Gregson, B., Tulu, S., Ercole, A., Solla, D. J. F., Paiva, W. S., Hutchinson, P. J., & Kolias, A. G. (2020). Optimal Timing of External Ventricular Drainage after Severe Traumatic Brain Injury: A Systematic Review. Journal of Clinical Medicine, 9(6), 1996. https://doi.org/10.3390/jcm9061996
Dubey SP, Larawin V, Molumi CP. Intracranial spread of chronic middle ear suppuration. Am J Otolaryngol 2010; 31:73–7.
Ebel, F., Lichter, E., Mariani, L., Guzman, R., & Soleman, J. (2023). Rapid Versus Gradual Weaning of External Ventricular Drain: A Systematic Literature Review and Meta-analysis. Neurocritical care, 39(1), 250–259. https://doi.org/10.1007/s12028-023-01766-6
Gurung, Urmila; Anurag, 1; Ullah, K S2; Shrivastav, R P; Bhattarai, H. Otitic hydrocephalus. Indian Journal of Otology 17(4):p 167-169, Oct–Dec 2011. | DOI: 10.4103/0971-7749.94497
Hafidh MA, Keogh I, Walsh RM, et al. Otogenic intracranial complications. A 7-year retrospective review. Am J Otolaryngol 2006; 27:390–5
Haim Bassan, Rina Eshel, Inbal Golan, David Kohelet, Liat Ben Sira, Dror Mandel, Loren Levi, Shlomi Constantini, Liana Beni-Adani, Timing of external ventricular drainage and neurodevelopmental outcome in preterm infants with posthemorrhagic hydrocephalus, European Journal of Paediatric Neurology, Volume 16, Issue 6, 2012, Pages 662-670, ISSN 1090-3798, https://doi.org/10.1016/j.ejpn.2012.04.002.
Heppner, P. A., Schweder, P. M., Monteith, S. J., & Law, A. J. (2008). Acute hydrocephalus secondary to herpes simplex type II meningitis. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 15(10), 1157–1159. https://doi.org/10.1016/j.jocn.2007.07.001
Kuo-Wei Wang, Wen-Neng Chang, Hsueh-Wen Chang, Hung-Chen Wang, Cheng-Hsien Lu, Clinical relevance of hydrocephalus in bacterial meningitis in adults, Surgical Neurology, Volume 64, Issue 1, 2005, Pages 61-65, ISSN 0090-3019, https://doi.org/10.1016/j.surneu.2004.10.009.
Mahmood Sadoghi, Payman Dabirmoghaddam, Otitic hydrocephalus: case report and literature review, American Journal of Otolaryngology, Volume 28, Issue 3, 2007, Pages 187-190, ISSN 0196-0709, https://doi.org/10.1016/j.amjoto.2006.07.007.
Moral, M., Blanco, C., & Lorenzo, V. (2025). Otogenic Meningitis or Meningoencephalitis in 30 Dogs: Association Between Neurological Signs, Magnetic Resonance Imaging Findings, and Outcome. Veterinary Sciences, 12(5), 456. https://doi.org/10.3390/vetsci12050456
Nitta, A., Sasagawa, Y., & Nakada, M. (2025). Noncommunicating Hydrocephalus Caused by Aseptic Meningitis Can Be Treated With Endoscopic Third Ventriculostomy. Journal of medical cases, 16(4), 135–139. https://doi.org/10.14740/jmc5109
Ohbuchi, H., Hagiwara, S., Arai, N., Yoneyama, T., Takahashi, Y., Inazuka, M., Kubota, Y., Chernov, M., & Kasuya, H. (2021). Optimal timing and safety of the external ventricular drainage in patients with high-grade aneurysmal subarachnoid hemorrhage treated with endovascular coiling. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 88, 63–69. https://doi.org/10.1016/j.jocn.2021.03.003
Osborn, Alexander J.a; Blaser, Susanb; Papsin, Blake C.a. Decisions regarding intracranial complications from acute mastoiditis in children. Current Opinion in Otolaryngology & Head and Neck Surgery 19(6):p 478-485, December 2011. | DOI: 10.1097/MOO.0b013e32834b0d92
Patel KM, Almutairi A, Mafee MF. Acute otomastoiditis and its complications: role of imaging. Operative Techniques in Otolaryngology 2014; 25:21–8.
Rajshekhar, Vedantam. Management of hydrocephalus in patients with tuberculous meningitis. Neurology India 57(4):p 368-374, Jul–Aug 2009. | DOI: 10.4103/0028-3886.55572
Sandeep Bhardwaj, Mukesh Vij, Acute hydrocephalus: An atypical and rare presentation of herpes simplex viral encephalitis in adolescents, Interdisciplinary Neurosurgery, Volume 24, 2021, 101015, ISSN 2214-7519, https://doi.org/10.1016/j.inat.2020.101015.
Tariq, A., Aguilar-Salinas, P., Hanel, R. A., Naval, N., & Chmayssani, M. (2017). The role of ICP monitoring in meningitis. Neurosurgical Focus FOC, 43(5), E7. https://doi.org/10.3171/2017.8.FOCUS17419
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Eqiel Navadz Akthar Alami, Eko Aprilianto Handoko, Kamilka Taufiq, Arsyzilma Hakiim, Putri Fortuna Sari
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
