Basilar Artery Vasculitis Secondary to Sphenoid Sinusitis. Case Report.

Abstract

A 35-year-old male presented with basilar artery vasculitis secondary to sphenoid sinusitis manifesting as rapidly deteriorating symptoms including consciousness disturbance and right hemiparesis. Computed tomography (CT) on admission showed sphenoid sinusitis without intracranial lesion. Emergency angiography demonstrated basilar artery stenosis. The neurological deterioration was considered to be caused by ischemia of the perforating arteries branching from the stenotic portion of the basilar artery. The patient was treated with urokinase infusion through a microcatheter just proximal to the stenosis 3 hours after the onset of the symptoms. His consciousness level and right hemiparesis markedly improved immediately after the procedure. Magnetic resonance (MR) imaging on day 5 revealed that extension of the sphenoid sinusitis into the prepontine cistern had formed an abscess which was attached to the clivus. The basilar artery was embedded in the abscess at the angiographic stenosis. Cerebrospinal fluid (CSF) analysis showed white blood cell count of 601/mm 3 with 82% neutrophils, 89.2 mg/dl protein, and 31 mg/dl glucose. No causative organism in the CSF could be identified by smear or culture. Early MR imaging and CSF examination are recommended when patients present with both ischemic symptoms involving the basilar artery and opacification of the sphenoid sinus on CT to identify basilar artery vasculitis secondary to sphenoid sinusitis.

Risk of Stroke among Patients with Rhinosinusitis: A Population-Based Study in Taiwan

“…Occlusion of the carotid and basilar arteries in patients with sphenoid sinusitis has been reported. 14,22…”

“…Occlusion of the carotid and basilar arteries in patients with sphenoid sinusitis has been reported. 14,22 Second, inflammation is currently accepted as playing a central role in atherosclerotic initiation, plaque rupture, thrombosis, and stroke. 23 One previous study revealed that retained sinus fluids and sinus mucosa in sinusitis contain the inflammatory and procoagulant cytokine interleukin-1.…”

Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study

“…In fact, a previous paper reports fracture, vertigo, posterior headache, vomiting, and empyema in patients with sphenoidal sinus prolongations [2]. Recent reports of vasculitis of the basilar artery with ischemic infarction of the pons secondary to sphenoidal sinusitis [30], cases of spontaneous CSF fistula [31][32][33], and frequent exposure of the internal carotid arteries support this theory [34]. In addition, a thin clivus is a potentially weak region in cases of a skull-base fracture, a point Correlation between radiological images and anatomical specimens to study sphenoidal aeration was first performed in 1925 by Canuyt and Terracol [12].…”

Somnolence in a pediatric acute sphenoid sinusitis case

“…The observed somnolence reminiscent of encephalitis was extremely unique and was attributed to the decreased consciousness level because it is clearly beyond the physiological range, such as sleepiness because of lack of sleep. To date, only one adult case presenting with basilar artery vasculitis secondary to sphenoid sinusitis manifesting as consciousness disturbance has been reported 3 . Moreover, Clement et al .…”

“…sphenoid sinusitis manifesting as consciousness disturbance has been reported. 3 Moreover, Clement et al reported a case series and systematic review of literature of ASS in children, revealing that 20 (28.2%) out of 71 patients identified across the 10 studies had one or more neurological signs at presentation in the form of cranial nerve neuropathies (21.1%) and decreased consciousness (12.7%). 4 As far as we are aware, there have been no reports of cases with sphenoid sinusitis presenting as somnolence.…”