Intracranial infection associated with preseptal and orbital cellulitis in the pediatric patient

Reynolds, Dorothy J; Kodsi, Sylvia R.; Rubin, Steven E.; Rodgers, I. Rand

doi:10.1016/j.jaapos.2003.09.013

Cited by 62 publications

(35 citation statements)

References 36 publications

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“…Our data are the first to compare inflammatory markers in children with uncomplicated sinusitis to children with SIE, although others have reported elevated ESR and/or WBC count in their SIE patients. 6,16 Although this study does not determine a value in which CRP and ESR can distinguish SIE from uncomplicated sinusitis, it does show that CRP level and ESR can be useful screening tools in this situation. Most patients with uncomplicated sinusitis in our study did not have CRP and ESR values in the range of SIE patients.…”

Section: Discussionmentioning

confidence: 75%

“…[11][12][13][14] Herrmann and Forsen 15 recently described a case series in which 4 of 43 pediatric patients Ͼ7 years old admitted for orbital sinogenic complications were also diagnosed with intracranial infections. Reynolds et al 16 also reported a case series of 10 immunocompetent pediatric patients with periorbital or orbital cellulitis and concurrent SIE. Four of their patients also had Pott's puffy tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings along with those of others emphasize the critical need to perform appropriate imaging of the brain and its coverings in addition to the orbits and maxillofacial region in patients who present with signs of known sinogenic complications. 3,4,7,15,16 In addition to physical findings, laboratory data may be helpful in determining which children might benefit from imaging of the brain. Our data are the first to compare inflammatory markers in children with uncomplicated sinusitis to children with SIE, although others have reported elevated ESR and/or WBC count in their SIE patients.…”

Section: Discussionmentioning

confidence: 99%

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Sinogenic Intracranial Empyema in Children

2005

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ABSTRACT. Background. Sinogenic intracranial empyema (SIE) is an uncommon complication of sinusitis that can lead to devastating neurologic sequelae. Early recognition of the clinical findings is critical so that proper management can be instituted.Objective. To describe the symptoms, signs, and laboratory and imaging findings from one of the largest pediatric SIE case series reported.Methods Results. Twelve children with SIE were identified. The median age of children with SIE was 11.5 years. Symptoms were usually present 10 days (median) before diagnosis and included headache (10), fever (11), nausea/ vomiting (7), mental-status changes (5), and seizures (3). Physical findings included abnormal neurologic examination (9), Pott's puffy tumor (4), and orbital cellulitis (3). Using the Intermountain Health Care system's computerized database, 142 children with uncomplicated sinusitis treated as outpatients were identified. Children with SIE had markedly higher CRP levels (median: 10.05 mg/ dL) and ESRs (median: 87 mm/hour) than those with uncomplicated sinusitis (median CRP: 0.7 mg/dL; median ESR: 6 mm/hour). Four children had hyperglycemia. Four children had a lumbar puncture at presentation, and the findings were normal for all of them. Craniofacial imaging included computed tomography (CT) and magnetic resonance imaging (MRI). SIE was not detected in 4 patients who had nonenhanced CT. Axial imaging alone was unable to demonstrate SIE in 1 child with sphenoid and ethmoid sinusitis, and coronal images were needed to demonstrate its presence and extent. The initial facial/ orbital imaging studies in 2 patients with physical signs of complicated sinusitis (orbital cellulitis and Pott's puffy tumor) were not adequate to detect SIE. Using contrast-enhanced head CT or MRI, SIE was diagnosed in all 12 children.Conclusions. Children with sinusitis and any neurologic finding, signs of complicated sinusitis such as Pott's puffy tumor or orbital cellulitis, or persistent headache, fever, or nausea and vomiting after antibiotic therapy should have additional evaluation for SIE. Children with hyperglycemia or diabetes may be at increased risk for SIE. The ESR and CRP levels are markedly elevated in children with SIE and may be useful screening tools. MRI with gadolinium is the preferred method to diagnose SIE. If MRI is unavailable, a contrast-enhanced head CT with axial and coronal planes should be obtained. Nonenhanced CT alone lacks sensitivity, and a normal study may be falsely reassuring.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sinogenic Intracranial Empyema in Children

2005

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“…Intracranial complications should be suspected in any patient aged more than seven years with preseptal or orbital cellulites associated with orbital subperiosteal abscess 7 . Urgent surgical evacuation of any intracranial collection is required.…”

Section: Discussionmentioning

confidence: 99%

Osteomyelitis of the frontal bone

Osei-Yeboah¹,

Neequaye²,

Bulley³

et al. 2010

Ghana Medical Journal

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SUMMARYOsteomyelitis of the skull is a rare clinical presentation. It usually occurs as a complication of trauma or sinusitis. Its complications can be life threatening though the initial symptoms and signs are subtle. Early diagnosis and appropriate management to prevent CNS complications reduce morbidity and mortality significantly. Intracranial complications of sinusitis, focal infections and meningitis remain a great challenge. Mortality from complications is 20-40%. The prevalence of skull osteomyelitis is about 1.5% of all osteomyelitis.

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“…Also, because the frontal sinus shares a thin posterior plate with the frontal cranial fossa, when the frontal sinusitis spreads to the brain; it most commonly results in an infection of the frontal lobe (7). An orbital subperiosteal abscess, which is a known complication of adjacent sinusitis, can be associated with frontal sinusitis and has been shown to place the patient with orbital cellulitis at a greater risk of intracranial involvement (7).…”

Section: Discussionmentioning

confidence: 99%