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[Brain abscess secondary to rhinosinusitis. Therapeutical modalities. Exposition of one case]
L A García González1, F Redondo Ventura, L Betancor Martínez
1Servicio ORL, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife. luisgarcia@comtf.es
Abstract:
Brain abscess (BA) as complication of sinusitis represent around 3% of the cases. Other suppurative intracraneal complications such as epidural abscess, subdural empyema and meningitis are more common than BA. The frontal and ethmoid sinuses form an integral part of anterior and to a lesser extent middle skull base to which the dura is intimately related. Thrombophlebitis of veins associated with paranasal sinuses is considered to be the main route of intracraneal spread of infection. However, osteitis is an uncommon mechanism that typically involves frontal sinus. Chronic sinusitis more than fulminant course of acute sinusitis is often responsible for BA. Epidemiology of BA has changed with the increasing incidence of this infection in inmunocompromised patient and the decreasing incidence related to sinus infection. Mortality rate of BA were around 35-55% before CT scan era and with surgical excision as the rule of surgical treatment.
Insights
Brain abscess (BA) is a rare complication of sinusitis, often caused by chronic sinus infections spreading through veins. While less common than other intracranial issues, understanding its mechanisms is crucial for patient outcomes.
Area of Science:
- Neurology
- Otolaryngology
- Infectious Diseases
Background:
- Brain abscess (BA) accounts for approximately 3% of sinusitis complications.
- Other suppurative intracranial complications like meningitis are more frequent than BA.
- The frontal and ethmoid sinuses are closely associated with the skull base, facilitating infection spread.
Observation:
- Intracranial spread of sinusitis-related infections primarily occurs via thrombophlebitis of associated veins.
- Osteitis, particularly involving the frontal sinus, represents an less common but significant route of infection.
- Chronic sinusitis is a more frequent precursor to BA than acute sinusitis.
Findings:
- Epidemiology of BA has shifted, with increased incidence in immunocompromised individuals and decreased incidence linked to sinus infections.
- Historically, mortality rates for BA ranged from 35-55% before the advent of CT scanning and routine surgical excision.
Implications:
- Understanding venous thrombophlebitis and osteitis pathways is key for preventing BA.
- Changes in BA epidemiology necessitate updated diagnostic and treatment strategies, especially for immunocompromised patients.
- Advances in imaging and surgical techniques have likely improved outcomes for brain abscess patients.
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