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Central nervous system complications secondary to oto-rhinologic infections. An analysis of 39 pediatric cases
Insights
Pediatric central nervous system (CNS) complications from oto-rhinologic infections are rare but serious. Early clinical examination is crucial for diagnosis, as antibiotics can mask symptoms.
Area of Science:
- Otolaryngology
- Pediatric Neurology
- Infectious Diseases
Background:
- Central nervous system (CNS) complications can arise from oto-rhinologic infections in children.
- These complications, though infrequent, carry significant morbidity and mortality.
Purpose of the Study:
- To analyze the incidence, types, and outcomes of CNS complications in pediatric patients with primary oto-rhinologic infections.
- To highlight diagnostic challenges and the importance of early clinical assessment.
Main Methods:
- Retrospective review of 39 pediatric patients diagnosed with CNS complications secondary to oto-rhinologic infections.
- Analysis of patient demographics, complication types, treatment, and outcomes.
Main Results:
- Fifty-eight CNS complications were identified in 39 pediatric patients (ages 1-15).
- Leptomeningitis (54%) and lateral sinus thrombosis (LST, 26%) were most common intracranial complications.
- Brain abscesses were associated with the highest mortality rate (40%).
Conclusions:
- Early clinical oto-rhinologic examination is vital for diagnosing CNS complications, especially with antibiotic masking.
- While advanced imaging is valuable, identifying the primary upper respiratory tract infection is key.
- Bone scans can aid in detecting associated osteitis.
Abstract:
Fifty-eight central nervous system complications were noted in 39 pediatric patients with a primary oto-rhinological infection. The ages ranged from 1 to 15 years. Eleven patients (25%) had more than one complication. 12.8% of the cases died. Leptomeningitis was the most common intracranial complication (54%) Lateral sinus thrombosis (LST) occurring in 10 patients (26%) was accompanied with other intracranial abnormalities in 80% of cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (40%). In two of these fatal cases multiple brain abscesses were detected. The low incidence of intracranial infections secondary to oto-rhinologic infections and the masking effect of antibiotics present difficulties in the early recognition of the CNS complication. Despite the value of the modern imaging techniques in the investigation of the CNS complication, the clinical oto-rhinologic examination is of paramount importance in detecting the original infection in the pneumatic spaces of the upper respiratory tract. Additionally, bone scans were found of value in demonstrating the osteitic process of these cases.