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Suppurative intracranial complications of sinusitis in children
Yew Kwang Ong1, Henry Kun Kiaang Tan
1Division of Otolaryngology, Department of Surgery, KK Women and Children's Hospital, Singapore.
Insights
Intracranial complications from sinusitis, including subdural empyema and meningitis, primarily affect teenage males. Prompt diagnosis with imaging and aggressive treatment combining antibiotics and surgical drainage are crucial for favorable outcomes in pediatric sinusitis complications.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Sinusitis is a common childhood illness.
- Suppurative intracranial complications of sinusitis are rare but serious.
- These complications can lead to significant morbidity and mortality if not managed promptly.
Purpose of the Study:
- To review cases of suppurative intracranial complications of sinusitis in children.
- To identify risk factors and common presentations.
- To evaluate treatment outcomes and recommend management strategies.
Main Methods:
- A retrospective case series review was conducted over a two-year period (1998-1999) at a children's hospital in Singapore.
- Seven pediatric patients with suppurative intracranial complications of sinusitis were analyzed.
- Data collected included patient demographics, clinical presentation, diagnostic imaging, microbiological findings, treatment, and outcomes.
Main Results:
- Seven male patients aged 9-14 years were identified, with six cases of subdural empyema and one of meningitis.
- Common symptoms were fever, headache, and vomiting; sinusitis was initially suspected in only one patient.
- All patients received high-dose intravenous antibiotics and surgical drainage; five required repeated intracranial drainage. Streptococcus species were common isolates.
Conclusions:
- Teenage males appear to be at higher risk for intracranial infections secondary to sinusitis.
- Radiologic imaging for suspected intracranial infection should include sinuses for early diagnosis.
- Aggressive combined surgical and medical treatment is recommended for favorable outcomes in pediatric sinusitis-related intracranial infections.
Objective:
A review of suppurative intracranial complications of sinusitis in children.
Methods:
Case series review over a two-year period from 1998 to 1999 in a children's hospital, Singapore.
Results:
There were seven cases, all male, and age range 9 to 14. Six had subdural empyemas and one had meningitis. The most common presenting symptoms included fever, headache and vomiting. Sinusitis was suspected as the cause in only one patient initially. The intracranial infections were not apparent from the initial brain CT of two patients and were only confirmed later on repeated imaging. Four patients had lumbar punctures without any adverse effects. All seven children had infections involving the frontal, ethmoid and maxillary sinuses and two also had sphenoid involvements. All were treated with high-dose intravenous antibiotics together with drainage of both the intracranial (n=six) and sinus (n=seven) suppurations. Five needed repeated intracranial drainages. Streptococcus species were isolated in five cases. Three patients developed seizures post-operatively which resolved on follow-up. One patient needed a ventriculo-peritoneal shunt for hydrocephalus. All patients had a good Glasgow Outcome Score. The hospital stay ranged from 30 to 89 days with a median of 43 days.
Conclusions:
Only males were identified in this review, collaborating the feeling that teenage males are at greatest risk of developing intracranial infections from sinusitis. We recommend that radiologic imaging of the brain for suspected intracranial infection should always include the sinuses as this aids early identification of actual cause. Initial CT imaging may be negative and hence repeated scans are warranted if the index of suspicion is high. The successful outcome of the children in this series supports the opinion that combined aggressive surgical and medical treatment is preferable in this patient population.