Infectious Intracranial Complications of Sinusitis, Other Than Meningitis, in Children: 12-Year Review

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.

Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

“…In medical literature the aerobic species cited as being among the most prevalent include S. aureus, 3,6,7,[11][12][13] H. influenzae, 1,2,6,9 S. milleri, 4,5 S. pneumoniae, 2,9,12 S. viridans 3,6 and M. catarrhalis. 2,9 The most frequently reported anaerobes include Peptostreptococcus, Prevotella, Fusobacterium, Propionibacterium and Bacteroides.…”

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

“…29 Typically, patients with intracranial complications of acute bacterial sinusitis are previously healthy adolescent males with frontal sinusitis. 33,34 There have been no head-to-head comparisons of the diagnostic accuracy of contrast-enhanced CT scanning to MRI with contrast in the evaluation of orbital and intracranial complications of sinusitis in children. In general, the contrast-enhanced CT scan has been the preferred imaging study when complications of sinusitis are suspected.…”

“…Intracranial complications are most frequently encountered in previously healthy adolescent males with frontal sinusitis. 33,34 In patients with altered mental status, severe headache, or Pott' s puffy tumor (osteomyelitis of the frontal bone), neurosurgical consultation should be obtained. A contrast-enhanced CT scan (preferably coronal thin cut) of the head, orbits, and sinuses is essential to confirm intracranial or intraorbital suppurative complications; in such cases, intravenous antibiotics should be started immediately.…”

Brain Infection After Cesarean Section: A Case of Subdural Empyema Post-Cesarean Section

“…One of them is mastoiditis or acute and chronic otitis media by erosion of the tegmen tympani (5) and the other one is spreading by erosion of the posterior wall of the frontal sinus (6). The infection may be caused by spreading the septic thromboemboli from thrombophlebitis or infected venous sinus thrombosis (7)(8)(9)(10). Subdural empyema may be difficult to diagnose due to nonspecific signs and symptoms (4,11,12).…”

“…The prognosis of the patient directly depends on early diagnosis and rapid initiation of appropriate antibiotic regimens and surgical intervention (13,14). The rate of a positive culture from surgically drained material and pus varies from 54% to 81% (6,10,15). Most common organisms secondary to sinusitis are anaerobes and in postoperative and post-traumatic are S. aureus (16,17).…”