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[Intracranial complication of sinusitis in a 18-year old patient]
S Piotrowski1, I Wojciechowski, I Zaniewska-Kulesza
1Oddział Laryngologii Szpitala MSW w Olsztynie.
Abstract:
We have described a case of intracranial complications, which were caused by acute inflammation of maxillary sinus. In our patient we observed the development of multilocular intracranial abscesses located in left temporal lobe. However intracranial complications of sinusitis are rare, but they are still a serious problem that results in high mortality. The dominant features were: nighttime headache, fever, amnestic aphasia. The patient was treated surgically--utilizing traditional operation Caldwell-Luce'a. A conservative treatment was administrated during a long period including high-doses of i.v. antibiotics. This kind of patients require an interdisciplinary approach--radiological, neurosurgical and otolaryngological. The diagnosis was made with the aid of X-ray, CT-scan and cerebrospinal fluid examination. In spite of very intensive treatment the patient was unconscious one week. Her condition improved in the third week of her admission. CT-scanning carried out in first week showed brain infection. Repetition of Ct-scans of the head evidenced progression of disease by forming multiple abscesses in left temporal lobe excluding any neurosurgical treatment. Finally the patient's condition improved in the third week of her admission. She was discharged after six weeks of treatment without cranial nerve palsies. Amnestic aphasia lasted next six months.
Insights
Intracranial complications from acute maxillary sinusitis are rare but serious, leading to brain abscesses. Early diagnosis and interdisciplinary treatment are crucial for patient recovery.
Area of Science:
- Neurology
- Otolaryngology
- Infectious Diseases
Background:
- Intracranial complications secondary to sinusitis, though infrequent, pose significant mortality risks.
- Acute maxillary sinusitis can lead to severe neurological sequelae, necessitating prompt medical attention.
Observation:
- A case presented with multilocular intracranial abscesses in the left temporal lobe secondary to acute maxillary sinusitis.
- Key symptoms included nocturnal headache, fever, and amnestic aphasia.
- Initial CT scans revealed brain infection, with subsequent scans showing progression and multiple abscess formation.
Findings:
- The patient underwent surgical intervention via the Caldwell-Luce procedure, alongside prolonged high-dose intravenous antibiotic therapy.
- Diagnosis was confirmed using X-ray, CT scans, and cerebrospinal fluid analysis.
- Despite intensive treatment, the patient remained unconscious for one week, with improvement noted by the third week.
Implications:
- This case underscores the necessity of an interdisciplinary approach involving radiology, neurosurgery, and otolaryngology for managing complex sinusitis-related intracranial complications.
- Effective management requires a combination of surgical and conservative treatments, including aggressive antibiotic regimens.
- While the patient recovered without cranial nerve deficits, residual amnestic aphasia persisted for six months, highlighting potential long-term neurological deficits.