Disclosures: Jennifer M. Cushman, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 73-yo-male presented to the Emergency-Department with nausea, headaches, dysmetria, left sensory and motor deficits, and with worsening unsteady gait for 3 days. This-patient had multiple ED admissions for similar presentation which included recurrent falls, dizziness, and worsening hearing-loss. CT scan revealed a right cerebellar posterior fossa abscess with vasogenic-edema and 4-mm midline-shift. He immediately underwent emergency craniectomy to relieve the mass-effect and drain the purulence. Post-surgery, his dysmetria, and the tendency to fall to one side improved. However, he required inpatient-rehabilitation to restore his other deficits and work on re-gaining his baseline function.

Case Description: A 73-yo-male presented with ataxia secondary to untreated Klebsiella mastoiditis

Setting: Emergency RoomAssessment/

Results: CT scan revealed a right cerebellar posterior fossa abscess with vasogenic-edema and 4-mm midline-shift needing emergency-craniectomy to relieve the mass-effect and drain the purulence. Post-surgery, his dysmetria, and the tendency to fall to one side improved.

Discussion: This patient was seen on multiple hospital-admissions for symptoms suggestive of a pathology of otologic origin. Due to low suspicion, his abscess was not discovered until his dysmetria and neurological changes became severe enough leading to further imaging. The delay in treating his mastoiditis led to cerebellar-abscess formation with prolonged suffering and the need for craniectomy. It is critical that the differential diagnosis include infections of the mastoid and inner ear and diagnose these infections earlier, before abscess formation and the need for emergent cerebellar resection.

Conclusion: Rehabilitation physicians often treat patients presenting with falls, dizziness, and disorders that are vestibular in nature. It is important when treating a patient with worsening cerebellar signs of imbalance and falls to consider this diagnosis in their work-up. This case highlights the rare-complications of untreated chronic-otitis-media and mastoiditis secondary to a Klebsiella infection.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-case-of-cerebellar-ataxia-an-intracranial-cerebellar-abscess-secondary-to-klebsiella-mastoiditis/