Intracranial Complications of Sinusitis

Abstract

Intracranial suppurative complications of sinusitis remain a challenging and contemporary topic. To determine the prevalence of sinogenic sources in intracranial infectious complications, we reviewed the records at a large public hospital between 1985 and 1995. There were 203 patients with 212 suppurative intracranial infections. Sinogenic sources were identified in 12 patients with 19 infections. Most patients had ethmoid or frontal sinusitis. We discuss the presentation, microbiology, diagnosis, treatment, and clinical course of these 12 cases. The diagnosis of intracranial complications of sinusitis requires a high index of suspicion and radiographic imaging of the head and paranasal sinuses. The mean hospital stay was 31.4 days and all 12 patients survived, although three patients had significant neurologic sequelae.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…[217][218][219][220][221] Sinus disease is the underlying cause of about 10% of intracranial suppuration, 222,223 and is associated with 10% to 90% of periorbital infections. 224 In large epidemiological studies, the overall incidence of complications ranged from 3 per million individuals per year in the Netherlands, 225 to 2.7 to 4.3 per million children per year in the United States (intracranial), 226 to 2.5 per million of population per year in France.…”

“…222,[226][227][228]231,[250][251][252] The clinical presentation of these complications can be nonspecific, characterized simply by high fever with severe, intractable headache, or even be silent. 228,253 The majority, however, present with more specific signs and symptoms that suggest intracranial involvement, such as nausea and vomiting, neck stiffness, and altered mental state.…”

“…259,263 Pathogens most commonly involved in the pathogenesis of intracranial complications are Streptococcus and Staphylococcus species and anaerobes. 222,261 Cavernous sinus thrombosis may present as bilateral lid drop, exophthalmos, ophthalmic nerve neuralgia, retroocular headache, complete ophthalmoplegia, papilledema, and/or signs of meningeal irritation associated with spiking fevers. 264 The cornerstone of diagnosis is MR venogram, demonstrating absence of venous flow in the affected cavernous sinus.…”

Odontogenic Pansinusitis Complicated by Orbital Cellulitis, Epidural Empyema and Intracerebral Abscess of Fronto-basal Region: Case Report

“…The intracranial complications of paranasal sinusitis include subdural empyema, epidural abscess, intracerebral (intraparenchymal) abscess, meningitis, cavernous sinus thrombosis and thrombosis of other venous sinuses. It is not uncommon for a patient to exhibit more than one focus of infection-intracranial or orbital, or both [14,15]. Most cases of sinusitis are uncomplicated and occur in the outpatient setting.…”

“…Most cases of sinusitis are uncomplicated and occur in the outpatient setting. Overall, sinus disease is the presumed underlying cause of about 10% of intracranial suppuration [12,14,15].…”