No abstract

Sinusitis is usually a mild illness in children, but intracranial complications can be life-threatening. We retrospectively reviewed nine cases of intracranial infections secondary to paranasal sinusitis that occurred over a 12-year period, excluding patients with orbital infection only. Cases were highly age- and sex-associated: the median age was 14 years, 89% of patients were > 9 years of age, and seven (78%) of the nine patients were male. Symptoms included fever (67%), headache (67%), eye swelling (56%), and seizure (33%). Rhinorrhea was uncommon (22%). Only two patients (22%) had had previous episodes of sinusitis. Staphylococcus aureus and anaerobes were the predominant intracranial isolates. Computed tomography scans of the head showed progression of disease in patients treated with antibiotics alone; surgical drainage was required for all patients. The duration of therapy after surgery was 3-8 weeks. Only one patient (11%) had persistent neurological sequelae. We conclude that (1) teenage males are at greatest risk of developing intracranial infections from sinusitis, (2) common symptoms of sinusitis such as rhinorrhea may not always occur, and (3) outcome can be excellent when a combined medical/surgical approach is used for therapy.

Neurocysticercosis has been diagnosed increasingly in the United States as a consequence of increased immigration from and travel to areas of endemic cysticercosis. We report a retrospective series of 47 pediatric cases of neurocysticercosis in our large children's hospital in Chicago, which has a large immigrant population. Neurocysticercosis was diagnosed on the basis of any of the following three criteria: (1) surgical biopsy findings, (2) radiographic findings consistent with neurocysticercosis as well as diagnostic serum and/or cerebrospinal fluid titers, or (3) consistent radiographic findings and a compatible epidemiologic history (without diagnostic serological findings). Epidemiologic, clinical, laboratory, and radiographic data were analyzed. Neurocysticercosis is a relatively common cause of afebrile seizures in children who present to our emergency department in Chicago. Computed tomography and magnetic resonance imaging are both important modalities in evaluation of children with neurocysticercosis. Laboratory studies are neither sensitive for nor predictive of the diagnosis of neurocysticercosis. Therapy is well tolerated. The long-term prognosis for treated patients appears to be excellent.