Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Intracranial abscess is a very infrequent complication of sinusitis among children. Case series, mostly small and focusing on surgical treatment, have appeared in the literature, but there has been no study on the epidemiology of this condition, nor has there been any large-scale study on the intensity of therapy or outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data were drawn from the Kids' Inpatient Databases for 1997, 2000, 2003, and 2006 and the National Inpatient Sample for 2001. Cases were defined by the conjunction between the diagnostic codes for intracranial abscess and those for acute or chronic sinusitis or mastoiditis.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eight hundred forty-seven hospital admissions were captured. Over the 10 years of the study, admission rates ranged between 2.74 and 4.38 per million children per year. Boys were affected much more commonly than girls. Black children were affected out of proportion to their presence in the population. The overall incidence seemed to peak in early adolescence. Sinogenic cases had a marked seasonal pattern peaking in winter, but no seasonal variation was seen for otogenic cases. Asthma comorbidity was more prevalent among sinogenic cases. The mortality rate was 2%, and death occurred only among sinogenic cases. Moreover, sinogenic cases tended to require more intensive therapy, as measured by the number of procedures, and there was a trend toward less favorable discharge dispositions. Older patients and black patients were less likely to be discharged directly to home. At least a quarter of the cases were managed without neurosurgical intervention. White patients were treated without neurosurgery more often than others.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Analysis of administrative data sets has yielded a descriptive picture of intracranial abscess complicating sinusitis among children, but the very low incidence of this condition impedes prospective clinical research directed at practical management issues.</jats:p></jats:sec>

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. 227 In almost all studies males are significantly more frequently affected than females [225][226][227] and ARS was more often the precipitating factor in children, whereas CRS with or without nasal polyposis was more important in adults.…”

“…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. 227 In almost all studies males are significantly more frequently affected than females [225][226][227] and ARS was more often the precipitating factor in children, whereas CRS with or without nasal polyposis was more important in adults. 228,229 The most common complications were orbital, appearing at least twice as often as intracranial, with osseous being the least common.…”

“…225,228,230 There was a clear seasonal pattern of complications, mirroring the incidence of URIs. 226 Although orbital complications tend to occur primarily in small children, intracranial …”

“…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.…”

Cerebral Abscess Secondary to Mild Scalp Infection: A Case Report and Literature Review

“…Generally, predisposing factors are present in most of the cases, with mastoiditis or otitis the first one, sinusitis the second and then meningitis and odontogenic infections [2]. There are also some sporadic reports of cerebral abscess secondary to some rare circumstances such as peritosillar surgery, eyelid pencil tip injury and paranasal sinus osteoma [3][4][5][6][7][8][9]. Here, we would like to report on an even rare case of cerebral abscess secondary to local spreading of mild scalp infection.…”