Management of Intracranial Complications of Sinusitis

Abstract

Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.

Giant Intra-Ventricular Calcified Meningioma in Childhood Manifest as Movement Disorders : A Extremely Rare Presentation

“…All patients were managed surgically [neurosurgical intervention and evacuation of the abscess, as early as possible] and most (83%) patients recovered to premorbid state without neurological sequelae. In another study [7] , neurological signs were the most frequent symptoms but contrary to our cases the rhinological signs were essentially purulent rhinorrhea and nasal obstruction. The duration of symptoms [pain and swelling on face] was shorter [3 days] contrary to 12 days, in series [5] .…”

“…The adult case had a subdural empyma, a common intra cranial complication of sinusitis as mentioned in the series [11,12,13] and in the child case it was the epidural abscess, commonly seen as in the series [8,14,15] . In a study [7] of 23 patients of ICS, as per CT scan there were subdural empymas (11 cases), extradural empymas (7 cases) and brain abscesses (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases.…”

Sepsis + ptosis = an unusual diagnosis

“…Presenting features of headache (as in our case), meningism, changes in consciousness and seizures6 may indicate an intracranial complication in the context of sinusitis, although fever is not a sensitive predictor (present in 50%–58%) 3. An acute onset with early development of focal neurology suggests a subdural empyema, which forms more rapidly than an extradural empyema.…”

“…As in our case, antiepileptic medications can be used prophylactically for intracranial complications 6. Currently, corticosteroids are indicated only in life-threatening cases of intracranial hypertension and cerebral oedema and are not recommended routinely 3. With all these strategies, the management approach should be multidisciplinary, with input from otolaryngologists, microbiologists, radiologists and neurosurgeons 1…”

“…This can leave 13%–35% of survivors with a long-term neurological consequence such as hemiparesis, aphasia, epilepsy and visual deficits 2. The prognosis is dependent on the nature of the neurological signs and the timings of diagnosis and commencement of treatment,3 necessitating the need for a high index of suspicion to aid rapid diagnosis and initiation of aggressive medical therapy and neurosurgical intervention.…”