Sinogenic intracranial complications

Abstract

Two hundred and nineteen patients, with intracranial complications of sinusitis, are presented. Sinusitis is still a life-threatening condition and if neglected, or mismanaged, can lead to intracranial complications that result in a high mortality and morbidity.Twenty-two patients had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema. The diagnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, chemistry and culture. The most frequent presenting signs were fever (68 per cent) and headache (54 per cent). The most common localizing neurological sign was hemiparesis (35.5 per cent). Orbital inflammation was present in 41.5 per cent of patients.Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, performed within 12 hours of admission. In patients with meningitis, the surgery entailed surgery of the sinus disease only. In patients with subdural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approach, immediately after drainage of the intracranial collection of pus, was carried out.There were 35 deaths (16 per cent). The highest mortality rate was recorded in patients with meningitis (45 per cent) followed by brain abscess (19 per cent) and subdural empyema (11 per cent). Despite advances in medicine, i.e. antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial complications has remained significant. This can only be eliminated through education. This paper emphasizes to younger generations of otolaryngologists and primary care physicians that sinusitis is a serious disease and there is no place for delay or complacency when managing such patients.

Complications of Sinusitis, Management with Limited Resources-: A Report of Two Cases with a Review of the Literature

“…Similar drainage of the abscesses [intra cranial, by neurosurgeon and involved sinuses by otolaryngologist] made most patients recovered to premorbid state without neurological sequelae [6] . Epidural abscesses progress slowly than subdural empymas and are diagnosed early [13,16] hence have better outcomes in management [11,14,16] . -Subdural empyma spreads rapidly and freely within a preformed space so it has a more culminant acute presentation with early neurologic deficits [10,17] .…”

Costo/efficacia della prevenzione di infezioni alle prime vie aeree mediante un estratto batterico immunostimolante aspecifico (OM-85)

“…Secondo alcuni studi riportati in letteratura, circa il 3% dei casi di OMA e di sinusite acuta in età pediatrica richiede il ricovero in ospedale [22][23][24][25][26][27][28][29][30][31]; in base a questo dato è stato assunto che circa il 65% delle OMA non rispondenti al trattamento di seconda linea e il 50% delle sinusiti con uguale decorso si risolvesse con l'ospedalizzazione.…”

Diagnosis and therapeutic management of sinusitis in children

“…A complicação precoce extra-sinusal fica definida pela disseminação da infecção sinusal para outro sítio anatômi-co, contíguo ou distante 57,88 . É reconhecida nos primeiros Foto 2 -Tomografia computadorizada no plano axial mostrando sinusite etmoidal e esfenoidal à direita, complicada com coleção líquida extraconal (abscesso) junto à parede medial da órbita dias de rinofaringossinusite nos pacientes em que há acometimento do tecido celular subcutâneo justa-sinusal, da órbita, intracraniano ou quadro de sepse 82 .…”

“…A clínica é febril, com variada toxemia, e as alterações ao exame físico são próprias dos locais infectados. Esses casos são graves, os pacientes são internados e recebem antibioticoterapia parenteral, que busca abranger as bactérias mais prováveis-Streptococcus pneumoniae e Haemophilus influenzae 57,82,88 . Geralmente prescreve-se uma cefalosporina de terceira geração-ceftriaxona ou cefotaxima, na dosagem de 50 a 100 mg/kg/dia 57 .…”

“…Geralmente prescreve-se uma cefalosporina de terceira geração-ceftriaxona ou cefotaxima, na dosagem de 50 a 100 mg/kg/dia 57 . Pelas peculiaridades envolvidas nesses tratamentos, inclusive pela possibilidade de intervenção cirúrgica, remetemos o leitor às revisões de terapêutica de meningite, abscesso cerebral, trombose de seio cavernoso assim como de abscesso intra-orbitá-rio 82,88 . Na Figura 2, observa-se abscesso intra-orbitário.…”