Simultaneous Orbital and Intracranial Abscesses in 17 Cases

Abstract

Purpose: To describe the demographics, clinical presentation, treatment, and outcomes of a rare cohort with simultaneous orbital and intracranial abscesses. Methods: A historical cohort study of 17 patients with simultaneous orbital and intracranial abscesses between 2010 and 2018 was performed. The demographics, location of abscesses, treatment, and outcomes of these patients were analyzed. Results: The mean age was 26.9 years (range 5–83 years). Fourteen patients (82%) were male. In this cohort, the most common orbital abscess location was the superior orbit, involved in 14 patients (82%). The most common site of intracranial abscess was the frontal lobe, involved in 16 patients (94%). Concurrent sinus disease was present in 16 patients (94%). Surgical evacuation was the standard of treatment, with 94% of patients undergoing at least one surgical procedure. Streptococcus species were the most common, isolated from 6 sinus cultures (43%), 3 orbitotomy cultures (21%), and 4 craniectomy cultures (36%). Staphylococcus species were also common. Most patients (94%) had stable or improved mental status and visual function at the conclusion of their treatment. Conclusions: Simultaneous orbital and intracranial abscesses are rare. Local invasion from the orbit into the intracranial space may occur from direct spread, thus superior orbital abscesses pose the greatest risk for intracranial spread. Additional factors such as infection with Streptococcus and Staphylococcus species as well as male sex appear to be risk factors for intracranial spread. For those who develop intracranial abscesses, young age and absence of seizures or altered mental status at presentation may be associated with favorable outcomes.

Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes

“…To the best of the authors' knowledge, there have been 3 cases of OA managed nonsurgically reported in the literature. 15,16,41 Two were pediatric patients, including a 7-year-old girl with a small intraconal OA treated successfully with ceftriaxone and an 8-year-old boy with a superior OA and frontal epidural abscess discharged after 5 days of IV antibiotic therapy, both with limited additional case information. 15,41 The only reported adult OA patient successfully managed nonsurgically was a 54-year-old woman who developed an OA following sub-Tenon's injection of a steroid after laser photocoagulation for diabetic macular edema.…”

“…15,16,41 Two were pediatric patients, including a 7-year-old girl with a small intraconal OA treated successfully with ceftriaxone and an 8-year-old boy with a superior OA and frontal epidural abscess discharged after 5 days of IV antibiotic therapy, both with limited additional case information. 15,41 The only reported adult OA patient successfully managed nonsurgically was a 54-year-old woman who developed an OA following sub-Tenon's injection of a steroid after laser photocoagulation for diabetic macular edema. 16 She was treated with IV ciprofloxacin 500 mg twice daily, vancomycin 1 g twice daily, and metronidazole 80 mg twice daily, which achieved full infection resolution with sequelae of conjunctival and corneal scarring.…”