Headache and high ESR: A cautionary tale

Area of Science:

• Neurology
• Infectious Diseases
• Otolaryngology

Background:

• Temporal headache and elevated ESR can mimic giant cell arteritis.
• Cranial nerve palsies may indicate serious underlying pathology beyond initial diagnosis.
• Sphenoid sinus infections can lead to severe intracranial complications.

Purpose of the Study:

• To highlight a rare case of sphenoid sinus abscess with intracranial extension.
• To discuss the diagnostic challenges and management of complex sinus infections.
• To emphasize the importance of considering non-arteritic causes for symptoms mimicking temporal arteritis.

Main Methods:

• Case report of a 69-year-old woman presenting with symptoms suggestive of temporal arteritis.
• Diagnostic workup including imaging to identify the source of intracranial complications.
• Multimodal treatment involving endoscopic sinus surgery, antibiotics, and anticoagulation.

Main Results:

• Initial diagnosis of temporal arteritis was revised upon discovery of a sphenoid sinus abscess with intracranial extension and cerebral venous sinus thrombosis.
• Endoscopic drainage of the abscess and subsequent medical management resulted in complete resolution of symptoms.
• The patient experienced a full recovery within two months.

Conclusions:

• Sphenoid sinus abscess is a critical differential diagnosis in patients presenting with headache and cranial nerve palsies, especially when initial diagnoses are uncertain.
• Early and aggressive management combining surgical and medical interventions is crucial for favorable outcomes.
• This case underscores the potential for severe neurological complications arising from contiguous spread of sinonasal infections.