The intracranial complications which I shall consider are—
- Meningitis.
- Sinus thrombosis.
- Brain abscess.
The meningitis may be serous or suppurative, and later localized or diffuse.
The sinus thrombosis may be partial or parietal, and complete with or without involvement of the jugular bulb and vein. The brain abscess may be extradural or genuine within the brain substance proper. The complications may be further divided as to bacteriologic or etiologic factors as, for instance—
- Streptococcic
- Staphylococcic
- Pneumococcic
- Tuberculous
- Syphilitic
These complications may arise following acute, or chronic and acute, exacerbation of chronic suppuration of the ear and sinuses. Meningitis and sinus thrombosis (this latter condition is very frequently associated with a localized meningitis) are usually complications following acute, or acute exacerbation of chronic, suppuration of the ear and sinuses. Brain abscess, however, is most frequently associated with the chronic form of the ear and sinus disease; but these become more manifest following an acute attack of ear or sinus trouble. Tubercular or syphilitic meningitis is chronic inflammation per se; but these conditions are also lit up by the acute processes within the ear and sinuses.
The cardinal symptoms of any intracranial complications are—
1. Pain or headache.—This may be localized or diffuse; it is, however, very persistent and quite intense. It is in the recognition of this symptom that has helped me more than any other in suspecting intracranial trouble.
2. Nausea and vomiting.—This symptom is quite constant, especially early in the disease; and projectile vomiting is quite characteristic of intracranial pressure or irritation.
3. General septic appearance.—This of course will vary in the different conditions under consideration, but in all is it quite manifest.