Choked Discs Associated with Otitis Media

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Otologists are occasionally confronted with the problem in which the patient, making an apparently uncomplicated convalescence from an attack of otitis media, is found to have a choking of the optic discs. Because other symptoms of increased intracranial pressure are lacking, the condition may be called an optic neuritis. Spinal puncture in these cases, however, will usually disclose a high degree of intracranial pressure with no increase in the cell count of the spinal fluid.

In 1896, Quincke1 described a syndrome in which the signs of increased intracranial pressure were associated with the findings of clear cerebrospinal fluid on lumbar puncture. He called attention to its occurrence chiefly in young women and its association with ear infections, head injuries, and other factors. He believed that, in these cases, there was an excess of cerebrospinal fluid as a result of hypersecretion of the choroid plexus. He referred to the condition as serous meningitis.

Numerous terms have since been used to describe and label these cases. In the group in which an otitic infection apparently initiated the syndrome, different authors have supplied the name cerebral pseudo-abscess, meningismus, serous meningitis, serous ependymitis, arachnoiditis, hypertensive meningeal hydrops, toxic hydrocephalus, and otitic hydrocephalus.

During the past eight years, 23 patients have come to the Clinic presenting a high degree of intracranial pressure, the cause of which could not be adequately explained. Of these 23 cases an otitic infection initiated the syndrome in 10 instances. This high incidence of otitic infection naturally suggests that these cases. . .



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