Arterial brain infarction in complicated acute otitis media

SummaryWe report a rare case of acute otitis media (AOM) complicated by arterial brain infarction, meningitis and orbital cellulitis. Computed tomography (CT) initially showed suspected epidural abscess, coalescent mastoiditis, and orbital cellulitis. Further clinical deterioration occurred following mastoidectomy and evacuation of the abscess. Magnetic resonance imaging (MRI) revealed subacute brain infarction and an extra-axial brainstem abscess. Revision of the initial CT revealed subtle signs suggestive of arterial brain infarction. Although CT with contrast is the standard of care for suspected AOM complications, MRI should be considered as an adjunct when CT is not definitive and neurological signs are present.