Endocranial transfer of infection due to sinusitis

Objective and Methodology:

Case reports of two children with intracranial and orbital complications of paranasal sinusitis.

Results:

Patient 1: Ten year old boy with frontal cephalgia, fever with minimal anterior rhinorrhoea since two days. Focal seizure occurred during hospital admission. CT of the sinuses and MRI: Paranasal sinusitis on the right side without bone destruction. Meningitis with leptomeningeal infection on the right frontal. Therapy: Pansinus surgery on the right side. Due to recurrent bifrontal subdural and epidural empyema and extraconal orbital abscess on the left side, repeated burrhole trepanation and orbital drainage and pansinus surgery on the left. Discharge after 42 days.

Patient 2: Twelve year old boy with high fever, confusional state and recurrent flaccid paresis of the right foot. 4 days in advance occasional frontal cephalgia with diarrhoea and vomiting. CT of the sinuses and MRI: maxillary and ethmoidal sinusitis on both sides, subdural empyema parafalxial. Therapy: Pansinus surgery on both sides with burrhole trepanation. Several re-trepanations and nasal irrigations for recurrent multifocal subdural empyema. Discharge after 27 days with persistent peroneal nerve palsy on the right side.

Conclusion:

Sinugeneous endocranial complications may develop without the typical symptoms of sinusitis. When suspicion arises, immediate imaging and, in case of confirmation, surgical treatment of the paranasal sinuses and neurosurgical intervention with extended antibiotic therapy are required. Targeted and short-term arrangements between all participants with permanent contact persons are needed to avoid time loss. Regular MRI monitoring must be planned in advance. Diagnostic testing concerning immune defects must be implemented.

Publication History

Publication Date:
18 April 2018 (online)