Related Experiment Videos
Sinusitis-induced subdural empyema
R Skelton1, W Maixner, D Isaacs
1Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children, Camperdown, Australia.
Insights
Sinusitis can lead to serious brain infections like subdural or extradural empyema in children. Prompt diagnosis and surgical intervention are crucial for recovery, even if initial scans are normal.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Sinusitis-induced intracranial empyema is a rare but serious complication in children.
- Delayed diagnosis can lead to significant morbidity and mortality.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and management of sinusitis-induced subdural or extradural empyema in children.
- To highlight the challenges in early diagnosis and the importance of surgical intervention.
Main Methods:
- Retrospective case series of 10 children managed for sinusitis-induced empyema between 1975 and 1991.
- Analysis of clinical data, diagnostic imaging (computed tomography), microbiology, and treatment outcomes.
Main Results:
- The mean age of affected children was 11 years.
- Common symptoms included headache, fever, vomiting, and neurological abnormalities, alongside signs of sinusitis.
- Initial computed tomography scans were normal in 50% of cases, with diagnosis often requiring serial imaging.
- Streptococcus milleri was the most common pathogen identified.
- All patients required surgical intervention for resolution despite initial medical management.
Conclusions:
- Sinusitis-induced empyema in children often presents with non-specific symptoms and can be missed on initial imaging.
- Early and aggressive surgical management is essential for favorable outcomes.
- Prompt recognition of clinical signs suggestive of sinusitis is critical for timely diagnosis.
Abstract:
Over a 17 year period, 1975-91, 10 children were managed who had sinusitis-induced subdural or extradural empyema. Their ages ranged from 6 to 14 years, with a mean of 11 years. All presented with worsening headaches, fever, vomiting, all had neurological abnormalities, and all had symptoms or signs suggestive of sinusitis. Initial computed tomography gave normal results in five cases and the empyema was diagnosed on the second or third scan. All patients had symptoms for at least one to two weeks before the diagnosis was made. Streptococcus milleri was the organism most frequently implicated. Medical treatment was started in all cases on admission, but all required surgical intervention before resolution.