Sinusitis refers to inflammation in the sinuses. Complications of sinusitis are rare and most often affect the orbit. However, in rare cases, these complications may be intracranial. One of these intracranial complications is subdural empyema, which is a loculated suppuration between the dura mater and the arachnoid. Despite its rarity, it has a high mortality rate and is often underestimated by physicians. We report here a rare case of a 5-year-old girl with a subdural empyema secondary to contralateral sinusitis. She was admitted to a local hospital complaining of fever, nasal congestion and headache for 6 days. Antibiotic therapy was initiated on admission. After six days, the patient maintained the previous symptoms and developed a decreased level of consciousness, a right hemiparesis and had a witnessed tonic-clonic seizure. This prompt her transfer to a tertiary hospital for brain computed tomography (CT) scan, which revealed a left subdural collection and a right maxillo-sphenoid sinusitis. She was referred to neurosurgical care and underwent surgical drainage of the empyema. There were another two complications of sinusitis: periorbital cellulitis and frontal osteomyelitis (both on the right). The patient was discharged from the tertiary hospital on day 39 without neurological sequelae. This case shows a rare complication of sinusitis and its clinical, surgical and radiological features and reinforces to physicians the importance of being aware of the possible complications of sinusitis. The peculiarity of the case is attributable to the way in which bacterial spread from sinusitis to a contralateral subdural empyema occurred.
Context: Brain venous thrombosis (BVT) is uncommon and usually has a different clinic and treatment from cerebral arterial thrombosis. In this context, COVID-19 correlates with thrombogenesis with varied clinical repercussions. This report describes an unusual BVT case as a possible late complication of COVID-19. Case report: Male, 68 years old, athlete and healthy. April/2020: COVID-19 mild symptoms. February/2021: in road-running, he fell due to sudden left hemiparesis. Upon hospital admission: contacting, persistent headache. A week after, low level of consciousness and coma, when underwent right hemicraniectomy. Remains hospitalized. On examination: weak gestural communication, tracheostomy, enteral tube feeding, voluntary blinking. Maintains neutral cervical posture, masticatory automatisms, photoreactive isocoria, generalized rigidity, decorticated right hemiparesis, left hemiplegia. On imaging: hemorrhagic infarction on the right and mass effect due to obstruction of the Basal Rosenthal and Labbé veins and transverse sinus on the right, with venous blood flow in the rest of the hemisphere diverted to the ipsilateral internal jugular vein, by anastomotic veins of the occipital foramen and suboccipital venous plexus. Obstructed left internal jugular vein, with venous collateral flow from the left hemisphere via posterior intercavernous sinus and basilar plexus to the right internal jugular vein. Conclusions: To diagnose the venous etiology that resembled segmental occlusion of the right middle cerebral artery, CT angiography was required. Late evolution of COVID-19 has been identified by the persistence of symptoms for months. Although physical activity and possible dehydration may have contributed to BVT, a prothrombotic state correlated to COVID-19 cannot be discarded.
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