Intracranial Complications Of Acute Sinusitis Research Articles

Concomitant orbital and intracranial abscess

Background: Intracranial and orbital abscesses in combination together are rare complications of sinusitis. They can be life-threatening and can result in multiple sequelae.
 Case presentation: A 9-year-old female presented with left periorbital swelling, gaze restriction and headache. Following scans, she underwent emergency endoscopic sinus surgery, evacuation of the intraorbital empyema and stereotactic mini-craniectomy with the evacuation of the extradural empyema as a joint case. The patient recovered well and was discharged to complete intravenous antibiotics for 6 weeks.
 Conclusion: In the pediatric population intracranial complications of acute sinusitis can have more devastating consequences. Therefore prompt recognition and management are essential within a multidisciplinary team setting.
 We also highlight the rarity of concomitant multi-site abscess formation and the need to be vigilant for same.

Acute sinusitis in children with severe intracranial complications: two cases report

In the past year, two cases of acute rhinosinusitis have been treated in our department. The intracranial complications of acute sinusitis in children are rare in recent years,which is associated with the low immunity of children,and the untimely treatment of acute infection.The combination of CT and MRI examination can determine the type,scope,location of intracranial complications of acute sinusitis in children with acute sinusitis.Imaging examination is the key to diagnosis intracranial complications of acute rhinosinusitis.Surgical removal of lesions,combing with using sensitive antibiotics,can increase the cure rate of patients.

Two cases of intracranial complications of acute sinusitis

Two cases of intracranial complications of acute sinusitis

Intracranial complications of acute sinusitis in children: The role of endoscopic sinus surgery

ObjectiveTo study the role of endoscopic sinus surgery (ESS) in the management of intracranial complications of children with acute rhinosinusitis MethodsRetrospective chart review at a tertiary care pediatric hospital Main outcomesDemographics, intracranial complications, length of hospital stay (LOS), neurological sequelae, ESS, neurosurgical procedures ResultsTwenty-four children with a mean age (SD) of 12.9 years (+/-3.2) with an intracranial complication(s) of acute rhinosinusitis were identified between 2005-2016. A total of 22 were included and 15 (68%) of these were males. The most common complications were: subdural abscess (n=10), epidural abscess (n=10), meningitis (n=5), intraparenchymal abscess (n=5), and cavernous sinus thrombosis (n= 2). Neurologic symptoms included headache (n=12), hemiparesis (n=5) and aphasia (n=3). Average length of stay was 16 (+/- 9.2) days. Average follow up was 7 (+/-5.6) months. One patient had residual seizures and 1 had recurrent rhinosinusitis. Aphasia and hemiparesis resolved in all patients within 1 year. Nineteen (86%) patients had ESS within 4 days of admission. Fourteen patients (63%) had a neurosurgical procedure, 6 (27%) required more than 1 neurosurgical procedure. Six patients (27%) had concurrent neurosurgical drainage and ESS. Four patients (17%) had neurosurgical procedure followed by ESS and 3 patients (13%) were treated only by a neurosurgical procedure. Patients who underwent ESS prior to a neurosurgical procedure had significantly less risk of needing a neurosurgical intervention (OR = .02, p < .01). There was a significantly higher proportion of neurosurgical patients with positive Strep anginosus cultures compared to the ESS only group (85.7% vs 37.5%, p = .02). Studies with larger patient populations are needed to determine the role of ESS in the management of intracranial complications of children with acute rhinosinusitis. DiscussionEarly ESS may be associated with less need for neurosurgical procedures.

Reducing Surgical Revisions in Intracranial Complications of Pediatric Acute Sinusitis.

Objective (1) To describe the demographics and clinical course of children with intracranial complications of sinusitis. (2) To elucidate factors that predict revision surgery in this population, such as type of initial surgery. Study Design Case series with chart review. Setting Tertiary care academic children's hospital. Subjects and Methods A 15-year retrospective review identified 71 patients with intracranial complications of acute sinusitis. Primary outcome was need for revision surgery. Secondary outcomes were readmission, length of hospitalization, and long-term complications. Results This study is the largest to date examining this disease process. Overall, 69 (97%) patients had surgery; 33 (46%) required revision surgery. Half of the patients with frontal sinus opacification underwent frontal sinus surgery at presentation (endoscopic, trephination, or cranialization). There was no difference in revision surgery between patients who had frontal sinus surgery and those who did not. Patients with frontal sinus surgery did not have a higher rate of complications or chronic sinusitis ( P > .05). Subdural abscess was associated with multiple surgical procedures (odds ratio, 20.0; P < .01). Thirty-four patients (49%) required neurosurgery. These patients had a longer length of stay (odds ratio, 11.0; P < .01) and a higher readmission rate ( P = .02). During the mean 92-month follow-up, 22 patients (33%) had long-term complications, and there was 1 death (1.4%). Conclusion Almost half of this cohort required multiple surgical procedures. In particular, patients with subdural abscess had significantly higher rates of revision surgery. Type of frontal sinus surgery was not correlated with need for revision surgery and was not associated with an increased rate of complications.

Intracranial Complications of Acute Sinusitis on Brain CT

This 35-year-old woman presented to a peripheral hospital Accident and Emergency department in a moribund state. She was intubated, stabilized and transferred urgently to a tertiary centre. She had attended the hospital in the prior week with a diagnosis of sinusitis.&#x0D; An urgent CT brain was requested by the attending A and E officer which was undertaken on the basis of her low Glasgow coma scale (GCS). The paranasal sinuses were partially visualised on this investigation.&#x0D; Acute bacterial rhinosinusitis is a common disease presenting to both general practitioners and ENT surgeons. It is on the most part short-lived in duration responding to antibiotics and symptomatic medications. Rarely it may be associated with severe life threatening complications, in the form of intra-orbital extension or even less so intracranial complications. These typically occur in the pediatric and young adult population.1&#x0D; Cross-sectional imaging plays an essential role in the assessment of this small sub-set of patients and is largely and almost always in the first instance with CT.2 Computed Tomography is broadly available, even out of standard working hours, and facilitates the review of potential intracranial complications and thereby guide neurosurgical management. Given that a proportion of the paranasal sinuses are always visualised on a CT brain it is an important review area, especially in patients with sepsis.&#x0D; There are a number of well recognized intracranial complications of acute rhinosinusitis which include; meningitis, cerebral abscess, subdural empyema, cavernous sinus and dural venous thrombosis.3 Additional sequelae from the intracranial infection may result, such as arterial territory cerebral infarction, ventriculitis and hydrocephalus. &#x0D; Those patients in whom intracranial extension occurs often demonstrate bony destruction of the sinuses on imaging. Disease involving the frontal sinus is typically associated with intracranial complications, through foci of bony dehiscence or osteomyelitis involving the floor of the anterior cranial fossa.3 &#x0D; In this case the patient presented in a moribund state due to severe intracranial complications following failed treatment in the community. The initial CT imaging identified subdural collections (Figure 1a and 1b) as well as pan-sinusitis (Figure 2) and the suggestion of an arterial territory infarct (Figure 1a). The frontal sinus however was not involved in this instance.&#x0D; A complete CT study of the paranasal sinuses (with a dedicated paranasal sinuses protocol) is merited including isotropic reconstructions to review the bony integrity and aid the planning of ENT surgical intervention. An MRI brain if available would eloquently confirm the CT findings including confirmation of the acute parietal lobe infarct.4&#x0D; Neurosurgical drainage of the subdural empyemas was undertaken. Furthermore, functional endoscopic sinus surgery (FESS) was also performed with drainage of a large volume of pus from the sphenoid, ethmoidal and right maxillary sinuses.4&#x0D; This case demonstrates intracranial complications are not an entity unique to the paediatric population. When caring for patients with acute sinusitis always have a high index of suspicion for these potential complications and have a low threshold for engagement with radiology colleagues for imaging if concerned. &#x0D; &#x0D; REFERENCES&#x0D; &#x0D; Sultész M, Csákányi Z, Majoros T, Farkas Z, Katona G. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol. 2009 Nov;73(11):1507-12. DOI: 10.1016/j.ijporl.2009.04.027 PMID: 19500861&#x0D; Dankbaar JW, van Bemmel AJM, Pameijer FA. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 2015 Oct; 6(5): 509–518. doi: 10.1007/s13244-015-0424-y PMCID: PMC4569601&#x0D; Osborn MK, Steinberg JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 2007 Jan;7(1):62-7. DOI: 10.1016/S1473-3099(06)70688-0 PMID: 17182345&#x0D; Bickle IC. Intracranial complications of acute sinusitis. Case rID: 45559. Created 30 May 2016 in Radiopaedia.org ©2005-2017. [Cited 2017 June 13] Available from: https://radiopaedia.org/cases/intracranial-complications-of-acute-sinusitis.&#x0D;

Management of Intracranial Complications of Acute Sinusitis: Our Experience Regarding a Series of Clinical Cases

Sinusitis is a common ear, nose and throat disease which develops from viral or bacterial upper respiratory airway infection. Complications of rhinosinusitis vary from relatively benign to fatal and severe and have been classified into local (5-10%), orbital (60- 75%) and intracranial (15-20%) complications [1]. Intracranial complications consist of meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis and superior sagittal sinus thrombosis. We present a series of 3 cases of intracranial complications of acute paranasal sinusitis treated in our department of oto-rhino-laryngology from January to December 2015 and review the literature.

A Case of Simultaneous Orbital Cellulitis and Intracranial Complication

Purpose: To report a case of simultaneous orbital cellulitis and intracranial complications of acute sinusitis in a young patient. Case summary: The 11-year-old male presented with a one-day history of left periorbital erythematous swelling, fever and headache. He was diagnosed with acute sinusitis at the department of otorhinolaryngology, and endoscopic sinus drainage of pus was performed. However, the patient's symptoms did not improve. The next day, a subdural abscess was found on brain computed tomography. He was treated by external drainage of the periosteal abscess via a subbrow incision and systemic antibiotics, as well as anticonvulsant medication. Conclusions: Twenty days after external drainage and beginning systemic antibiotics and anticonvulsant treatment, he was discharged with improved orbital cellulitis symptoms and a resolved subdural abscess.

Increased incidence of head and neck abscesses in children

To describe increasing incidence and changing microbiology of head and neck abscesses in children admitted to the hospital during the first quarters of 2000 through 2003. Retrospective data warehouse review identified 89 children less than 19 years of age admitted to a tertiary care pediatric hospital during the first quarters of 2000 through 2003 for suspicion of head and neck abscess involving the neck, face, and peritonsillar, retropharyngeal, and parapharyngeal spaces; and for orbital and intracranial complications of acute sinusitis. Outcome measures included the incidence of infection admissions and description of infection location and microbiology, calculated by chi2 technique. The incidence of infections increased in 2003. The greatest increase was in neck abscesses and complications of acute sinusitis. The increase in group A strep infections may be related to its biologic properties. Group A strep remains a significant cause of head and neck infections in children.

Increased incidence of head and neck abscesses in children

Objectives: Describe the changing incidence, microbiology and management of head and neck abscesses in children admitted during the first quarters of 2000–2003. Methods: Retrospective chart and data warehouse review in a tertiary care pediatric hospital. A broad range of ICD-9 codes were used to identify 965 potentially appropriate patient encounters in children <19 years admitted during the first quarters of 2000–2003 with possible head and neck abscesses, excluding mastoiditis. Data review confirmed 89 relevant infections. Outcome measures included incidence of infections relative to total hospital admissions evaluated by chi-square technique and evaluation of abscess location, management, and microbiology. Results: Forty-two of 2310 hospital admissions (1.8%) during the first quarter of 2003 were compared to 13 of 1791 (0.7%), 18 of 2141 (0.8%), and 16 of 2192 admissions (0.7%) in 2000, 2001, and 2002, respectively ( P < 0.004). 38 peritonsillar, retropharyngeal or parapharyngeal infections; 26 neck infections; 13 orbital or intracranial complications of acute sinusitis; and 12 facial infections were identified. Sixty-six (74%) were managed surgically, 2 additional ones were drained by needle aspiration. Various streptococcal species were identified in 28 cultures, staphylococcus in 6, atypical mycobacterium in 3, and other organisms in 20; cultures from some patients revealed multiple organisms. Conclusions: The incidence and proportion of head and neck infections in children admitted to the study hospital increased significantly during the first quarter of 2003. The most common organism identified was group A streptococcus. This is in agreement with reports from other institutions of an increasing incidence of streptococcal infections.

Serious complications of acute sinusitis.

Acute sinusitis is common and usually the result of edema around the sinus ostia from the common cold. Chronic sinusitis and recurrent sinusitis are common complications of untreated or undertreated infection. Serious and life-threatening complications are uncommon but demand a high index of suspicion, accurate diagnosis, and rapid intervention by medical and surgical methods. Immediate parenteral administration of antibiotics may be necessary to prevent permanent disabilities or death, and early consultation with an otolaryngologist or neurosurgeon is prudent. Computed tomography is the imaging method of choice for detection of serious intracranial complications of acute sinusitis. Increasing numbers of immunocompromised patients and seriously ill hospitalized patients with problems related to complications of acute sinusitis are being seen.

Middle Cranial Fossa Epidural Abscess: An Unusual Complication of Acute Sinusitis

Intracranial complications of acute sinusitis usually are manifested as frontal lobe empyemas, and middle cranial fossa epidural abscesses are rare. We present an unusual case of middle cranial fossa epidural abscess as a direct complication of acute pansinusitis in a young man. The etiology of middle cranial fossa epidural abscess formation is similar to that of anterior cranial fossa (frontal lobe) abscess formation, but the treatment and surgical approaches are more complicated. We present the methods of communication of paranasal disease through the fascial planes into the subtemporal space and the lateral pharyngeal space. An evaluation of a patient who presents with fever and severe headache of sinus origin should commence with imaging scans and a team approach to treatment.