Sphenoid sinusitis: a rare cause of ischaemic stroke

Abstract

We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew Streptococcus constellatus, a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.

Cavernous sinus and jugular thromboses, base of skull osteomyelitis and cranial nerve palsies: catastrophic complications of sphenoid sinusitis

“…9 Sinusitis is defined as the inflammation of the paranasal sinuses and may be classified as acute or chronic, where chronic sinusitis involves symptoms for 12 weeks. 1 Typical pathogens, accounting for more than half of the cases, are Streptococcus pneumonia and Haemophilus influenzae. 10 Streptococcus milleri group are commensal oropharyngeal organisms, which are a less common cause of sinusitis and associated with head and neck abscesses.…”

“…10 Streptococcus milleri group are commensal oropharyngeal organisms, which are a less common cause of sinusitis and associated with head and neck abscesses. 1 Less than 3% of inflammatory lesions of the sinuses primarily involve the sphenoid sinus, with the sphenoid sinus being historically referred to as the 'neglected sinus'. 11 12 Isolated sphenoid sinus disease is rare and refers to unilateral cases.…”

“…If medical management is unsuccessful, surgical intervention can be considered. 1 Functional endoscopic sinus surgery is the standard surgical technique used to drain chronic and recurrent sinusitis. 3 The role of anticoagulation in sphenoid sinusitis complicated by thromboses, such as cavernous sinus thrombosis (CST), remains controversial.…”

“…Superiorly and posteriorly, it is related to the sella turcica and laterally by the cavernous sinus and middle cranial fossa. Sphenoid sinusitis may lead to devastating complications with contiguous involvement of the cavernous sinus and its contents, including the internal carotid artery and cranial nerves III, IV, V and VI 1 2. Management of sphenoid sinusitis includes antimicrobials, intranasal corticosteroids and topical decongestants.…”

“…Management of sphenoid sinusitis includes antimicrobials, intranasal corticosteroids and topical decongestants. If medical management is unsuccessful, surgical intervention can be considered 1. Functional endoscopic sinus surgery is the standard surgical technique used to drain chronic and recurrent sinusitis 3.…”