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Intracranial Suppurative Complications of Sinusitis
T K Nicoli1, M Oinas2, M Niemelä2
11 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Background:
Intracranial complications of paranasal sinusitis have become rare due to widespread and early use of antibiotics. Potentially life-threatening intracranial complications of sinusitis include subdural empyema, epidural and intracerebral abscess, meningitis, and sinus thrombosis. Patients with intracranial complication of sinusitis can present without neurological signs, which may delay diagnosis and correct treatment.
Aims:
Our aim was to evaluate the diagnostics, treatment, and outcome of sinusitis-related intracranial infections at our tertiary referral hospital with a catchment area of 1.9 million people.
Materials And Methods:
We retrospectively collected data on all patients diagnosed and treated with an intracranial infection at the Helsinki University Hospital, Helsinki, Finland, during a 10-year period between 2003 and 2013.
Results:
Six patients were diagnosed to have a sinusitis-related intracranial infection. Four patients had an epidural abscess, one both an epidural abscess and a subdural empyema and one a subdural empyema. The most common presenting complaint was headache (100%) followed by fever (83%), vomiting (50%), nasal congestion (50%), forehead lump (34%), and neck stiffness (17%). All patients were managed surgically. Most (83%) patients recovered to premorbid state without neurological sequelae. One patient died intraoperatively.
Conclusion:
Patients with a sinusitis-related intracranial suppuration typically present with signs of raised intracranial pressure rather than signs of sinusitis. Most are likely to need neurosurgical intervention and evacuation of the abscess without delay.
Insights
Intracranial infections from sinusitis are rare but serious. Prompt surgical treatment of sinusitis-related brain abscesses is crucial for good outcomes, though risks remain.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Otolaryngology
Background:
- Intracranial complications of paranasal sinusitis, including subdural empyema and brain abscess, are rare due to antibiotic use.
- These complications can be life-threatening and may present without obvious sinusitis symptoms, delaying diagnosis.
- Early recognition and treatment are vital for patient survival and preventing neurological deficits.
Purpose of the Study:
- To evaluate the diagnostic approaches, treatment strategies, and patient outcomes for intracranial infections secondary to sinusitis.
- To analyze a decade of cases at a major tertiary referral hospital.
Main Methods:
- Retrospective data collection of patients diagnosed with sinusitis-related intracranial infections.
- Study period: 2003-2013 at Helsinki University Hospital.
- Inclusion criteria: patients treated for intracranial infection originating from paranasal sinusitis.
Main Results:
- Six patients were identified with sinusitis-related intracranial infections (epidural abscess, subdural empyema).
- Common symptoms included headache (100%), fever (83%), and vomiting (50%), often overshadowing sinusitis signs.
- Surgical management was required for all patients; 83% recovered fully, but one patient died intraoperatively.
Conclusions:
- Sinusitis-related intracranial suppuration often presents with signs of increased intracranial pressure rather than direct sinusitis symptoms.
- Neurosurgical intervention and prompt abscess evacuation are typically necessary.
- Early diagnosis and surgical management improve patient prognosis, minimizing long-term neurological sequelae.
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