To the Editor:Morbidity and mortality associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are extremely visible 1 ; however, the effect of the COVID-19 pandemic on the management of other pathologies requiring complex interventions and critical care resources-the bystander effect 2 -is not well described. This is certainly true of stroke patients whose clinical outcomes are a function of early presentation, timely diagnosis, emergent intervention, and critical care management. [3][4][5] With the arrival of COVID-19 cases in the month of March in the hotspot of Michigan, we describe the bystander effect of the COVID-19 pandemic on ischemic and hemorrhagic stroke.
METHODSThis is a retrospective analysis of deidentified data submitted from 11 Comprehensive Stroke Centers (CSCs) and 1 Primary Stroke Center (PSC) in Michigan and northwest Ohio. The study was approved by the University Institutional Review Board. Patient consent was not required given the retrospective nature of the study. Using Poisson regression analysis, we calculated the incidence-rate ratios (IRRs) comparing the study period of March 2020 to each of the control periods (February 2020 and March 2019). Additionally, the unpaired t-test for continuous variables and the Chi-square test for categorical variables were used as appropriate.
BACKGROUND
Frontal mucoceles develop due to accumulation of mucoid secretions within the frontal sinuses. They can lead to serious consequences with further expansion and destruction of the surrounding bones or infection that might spread intracranially.
OBSERVATIONS
The authors present a case of a 37-year-old male with a frontal mucocele and the rare presentation of Pott’s puffy tumor and an epidural-cutaneous fistula, as well as a literature review of previously reported cases of epidural cutaneous fistula and sinocutaneous fistula, their predisposing factors, and their management.
LESSONS
A mucocele is a benign entity that can rarely present with potentially significant complications. Open surgery is required in patients who have frontal sinus posterior wall involvement, osteomyelitis, or intracranial involvement.
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