scholarly journals Intracranial Suppurative Complications of Sinusitis

2016 ◽  
Vol 105 (4) ◽  
pp. 254-262 ◽  
Author(s):  
T. K. Nicoli ◽  
M. Oinas ◽  
M. Niemelä ◽  
A. A. Mäkitie ◽  
T. Atula
Keyword(s):  
Epidural Abscess ◽  
Sinus Thrombosis ◽  
Nasal Congestion ◽  
Subdural Empyema ◽  
University Hospital ◽  
Tertiary Referral Hospital ◽  
Neck Stiffness ◽  
Correct Treatment ◽  
Intracranial Infection ◽  
Intracranial Complications

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.

scholarly journals Faciocranial complications of sinusitis

New Medicine ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Michał Michalik ◽  
Adrianna Podbielska-Kubera
Keyword(s):  
Sinus Thrombosis ◽  
Nasal Congestion ◽  
Empirical Therapy ◽  
Nasal Discharge ◽  
Anatomical Location ◽  
Fungal Sinusitis ◽  
Sagittal Sinus ◽  
Intracranial Complications ◽  
Life Threatening ◽  
Orbital Complications

Sinusitis is one of the most common conditions. The aetiology of sinusitis has not been fully discovered; however, viruses and bacteria are usually the dominant causes. The chief symptoms include nasal congestion, profuse nasal discharge and a compromised sense of smell. Inflammation of any sinus can be the source of complications. Complications develop usually as a result of exacerbation of chronic sinusitis. Sinusitis may result in inflammation spreading inside the cranium and to the orbital area and in the development of osteomyelitis or superior sagittal sinus thrombosis. Due to the anatomical location and proximity of important structures, sphenoid sinusitis may lead to meningitis or subdural empyemas, temporal lobe abscesses and cavernous sinus thrombosis. Fungal sinusitis is very dangerous since it is characterised by a rapid course often complicated by intracranial and orbital spread. Invasive fungal paranasal sinusitis with orbital complications is a life-threatening emergency. If there is concern about possible orbital or intracranial complications of sinusitis or if there is no improvement after initial empirical therapy, the use of diagnostic imaging is necessary, including computed tomography and magnetic resonance imaging. Early diagnosis of sinusitis and multidisciplinary management involving a combination of antibiotic therapy and surgical treatment, including neurosurgery and maxillofacial procedures can be effective in the prevention of complications and may significantly reduce morbidity and mortality.

scholarly journals Ten years incidence of intracranial complications of chronic suppurative otitis media

2020 ◽  
Vol 3 (6) ◽  
pp. 996-1001
Author(s):  
Khaled Mohamed Mokbel Khalefa
Keyword(s):  
Brain Abscess ◽  
Otitis Media ◽  
Sinus Thrombosis ◽  
University Hospital ◽  
Chronic Suppurative Otitis Media ◽  
Lateral Sinus ◽  
Suppurative Otitis Media ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Intracranial Complications

Background: complications of chronic Suppurative Otitis Media have mortality and morbidity risks which are caused by Reluctance in its management with late presentation. The aim of this study was to investigate, the frequency, mortality and morbidity of intracranial complications of chronic suppurative otitis media admitted at our tertiary University Hospital in ten years from 2006 -2016. Result: The total number of patients reported with intracranial complication due to chronic suppurative otitis media was 64 patients. Brain abscess and Meningitis were present in 24 (37.5%) and 22 cases (34.4%). In 14 cases (21.8%) extradural abscess was found while 4 (6.3%) had lateral sinus thrombosis. Conclusion: Brain abscess is the most common and dangerous complication in chronic suppurative otitis media in our region.

scholarly journals Epidural Abscess and Sigmoid Sinus Thrombosis as Intracranial Complications of the Middle Ear Cholesteatoma

2020 ◽  
Vol 21 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Dalibor Vranjes ◽  
Aleksandar Gajic ◽  
Svjetlana Jefic ◽  
Slobodan Spremo ◽  
Dmitar Travar ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Middle Ear ◽  
Epidural Abscess ◽  
Sinus Thrombosis ◽  
Prognostic Significance ◽  
Sigmoid Sinus ◽  
Bony Tissue ◽  
Intracranial Complication ◽  
Middle Ear Cholesteatoma ◽  
Intracranial Complications

AbstractThe otogenic intracranial complications are rare manifestations in modern era of antibiotics. An early antibiotic therapy often covers typical clinical signs and symptoms for each complication. A sigmoid sinus thrombosis is often associated with other intracranial complications, as in this case, an epidural abscess. We are presenting a case of 12-year-old girl with the sigmoid sinus thrombosis and epidural abscess as complications of chronic infection to the middle ear with cholesteatoma. In the active phase of chronic inflammation of the middle ear she was treated with the antibiotic therapy that covered early symptoms of intracranial complication development. A humid attic perforation of the tympanic membrane with protrusion of choleastoma and evident signs of bony wall destruction to the external auditory canal was noticed by performing routine otomicroscopy and otoendoscopic examination. Assuming intracranial complication, magnetic resonance imaging (MRI) of the endocranium was undertaken. The MRI showed inflammatory changes of both middle ears with intracranial complications: the right sigmoid sinus thrombosis and epidural abscess of the same side. During the surgery we have noticed an extensive middle ear cholesteatoma with significant destruction of the bony tissue and purulent collection between sigmoid sinus changed with granulation and respective dural segment of the posterior cranial cavity.Timely diagnosis, multidisciplinary approach with an adequate choice of the antibiotic therapy and surgical technique have a crucial prognostic significance.

Republished: Sinus thrombectomy for purulent cerebral venous sinus thrombosis utilizing a novel combination of the Trevo stent retriever and the Penumbra ACE aspiration catheter: the stent anchor with mobile aspiration technique

2015 ◽  
Vol 8 (6) ◽  
pp. e24-e24 ◽  
Author(s):  
Justin R Mascitelli ◽  
Margaret Pain ◽  
Hekmat K Zarzour ◽  
Peter Baxter ◽  
Saadi Ghatan ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Stent Retriever ◽  
Venous Sinus ◽  
Dramatic Improvement ◽  
Lower Extremity Weakness ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Aspiration Technique ◽  
Intracranial Complications

Intracranial complications of sinusitis are rare but life threatening. We present a case of a 17-year-old woman with sinusitis who deteriorated over the course of 12 days from subdural empyema and global purulent cerebral venous sinus thrombosis. The patient was managed with surgery and mechanical thrombectomy utilizing a novel ‘stent anchor with mobile aspiration technique’, in which a Trevo stent retriever (Stryker) was anchored in the superior sagittal sinus (SSS) while a 5 MAX ACE reperfusion catheter (Penumbra) was passed back and forth from the SSS to the sigmoid sinus with resultant dramatic improvement in venous outflow. The patient was extubated on postoperative day 3 and was discharged with minimal lower extremity weakness on postoperative day 11. This is the first report using the Trevo stent retriever for sinus thrombosis. It is important to keep these rare complications in mind when evaluating patients with oral and facial infections.

scholarly journals Multiple sclerosis in Kenya: Demographic and clinical characteristics of a registry cohort

2021 ◽  
Vol 7 (2) ◽  
pp. 205521732110227
Author(s):  
Imran Jamal ◽  
Jasmit Shah ◽  
Peter Mativo ◽  
Juzar Hooker ◽  
Mitchell Wallin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Symptom Onset ◽  
Clinical Characteristics ◽  
Age Of Onset ◽  
Sub Saharan Africa ◽  
University Hospital ◽  
Tertiary Referral Hospital ◽  
Female Ratio ◽  
Sub Saharan ◽  
Neuro Imaging

Background Multiple Sclerosis (MS) is the leading cause of non-traumatic neurological disability in young adults. There is limited literature regarding the burden of MS in sub-Saharan Africa (SSA). Objective To describe the demographic and clinical characteristics of patients with MS (PwMS) presenting to a tertiary referral hospital in Nairobi. Methods We conducted a retrospective descriptive study for PwMS presenting to Aga Khan University Hospital, Nairobi from 2008–2018. Results 99 cases met the diagnostic criteria for MS with a male to female ratio of 1:4. Majority (68.7%) of PwMS were indigenous Africans with a mean age of onset of 30.7 years. Mean duration from symptom onset to first neuro-imaging was 5.04 years. Only 33% of patients had sensory symptoms at onset whereas 54.5% had vitamin D deficiency/insufficiency. Majority (79.5%) had relapsing remitting MS (RRMS) and 56.6% were initiated on disease modifying therapy (DMT). Only 21.2% of patients on DMT were non-compliant. Patients with RRMS were more likely to be initiated on DMT at our hospital (p < 0.001). Conclusion Clinical characteristics of these patients largely resemble those of other SSA cohorts and African American patients. There was a delay between symptom onset and neuroimaging. There were also issues with DMT compliance.

Surgical corridors for congenital aural atresia with otogenic cerebellar abscess and lateral sinus thrombosis

2021 ◽  
Vol 14 (5) ◽  
pp. e239403
Author(s):  
Saranya Thangavel ◽  
Lokesh Kumar Penubarthi ◽  
Arun Alexander ◽  
Sunil Kumar Saxena
Keyword(s):  
Case Report ◽  
Facial Palsy ◽  
Multidisciplinary Approach ◽  
Sinus Thrombosis ◽  
Lateral Sinus ◽  
Aural Atresia ◽  
Lateral Sinus Thrombosis ◽  
Cerebellar Abscess ◽  
Intracranial Complications ◽  
Congenital Aural Atresia

The following is a case report of an adolescent with mental retardation who had congenital aural atresia with contralateral congenital facial palsy. She developed multiple intracranial complications (cerebellar abscess and lateral sinus thrombosis) due to cholesteatoma. We managed her in a multidisciplinary approach. This report discusses case management, emphasising the meticulous intraoperative steps taken in identifying the landmarks and precautions adopted to avoid postoperative facial palsy and other complications.

scholarly journals Latvian experience in conservative management of abnormally invasive placenta: two case reports

2020 ◽  
Vol 26 (3) ◽  
pp. 153-158
Author(s):  
Diana Bokučava ◽  
Sandra Vītiņa ◽  
Maira Jansone ◽  
Mara Tirāne ◽  
Zane Krastiņa ◽  
...  
Keyword(s):  
Conservative Management ◽  
Case Reports ◽  
Placental Tissue ◽  
University Hospital ◽  
Tertiary Referral Hospital ◽  
Excessive Bleeding ◽  
Section Operation ◽  
Invasive Placenta ◽  
New Treatment

Background. Abnormally invasive placentation (AIP) is a clinical term that describes situation when placenta does not separate spontaneously after delivery and its manual removal causes excessive bleeding (1). Historically, the treatment of choice for this condition is hysterectomy. Lately, the new treatment option, conservative management of the AIP, has proven itself an effective alternative to hysterectomy in carefully selected patients (2). However, the use of conservative AIP management is limited in many countries, the reasoning being the lack of doctors’ experience in this procedure and concerns regarding a high postpartum infection rate. Case reports. We present the first two cases of conservative management of AIP in Latvia. Most of prenatally diagnosed AIP cases country-wide are referred to the Paul Stradinš University Hospital, which is a tertiary referral hospital. The annual rate of AIP in the hospital varies from five to ten cases. Two pregnant women were diagnosed with AIP prenatally, both of them refused hysterectomy and therefore went for the conservative management of AIP. During Caesarean section operation, placentas were left in situ after delivery of the baby. During the follow-up period of 12 and 14 weeks, both women developed infection complications, but complete placental tissue resolution was diagnosed in the end. Conclusion. These two cases demonstrate that conservative management of AIP can be safely applied in small countries/areas with small AIP rate and management experience.

scholarly journals 1214. Microbiological and Clinical Effectiveness of Pulsed-Xenon Ultraviolet Disinfection of the Patient Room in the ICU

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S436-S437
Author(s):  
Keita Morikane ◽  
Shoko Suzuki ◽  
Jun Yoshioka ◽  
Jun Yakuwa ◽  
Masaki Nakane
Keyword(s):  
Clinical Effectiveness ◽  
Healthcare Setting ◽  
Baseline Period ◽  
University Hospital ◽  
Intervention Period ◽  
Tertiary Referral Hospital ◽  
Contact Precautions ◽  
Healthcare Settings ◽  
Route Of Transmission ◽  
The Us

Abstract Background Contact precautions do not necessarily control transmission of MDROs as other route of transmission such as patient environment may be significant. No-touch environmental disinfection has been highlighted in the past several years to control transmission of MDROs. The effectiveness of portable Pulsed Xenon Ultraviolet (PX-UV) device has been examined and demonstrated in US healthcare settings. However, its effectiveness outside the US healthcare setting is seldom reported. Methods This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. The ICU has six rooms and beds. In the baseline period (August 2016 to January 2018), all rooms were manually cleaned after every patient transfer/discharge. In the intervention period (February 2018 to February 2019), PX-UV disinfection was added after the manual cleaning. In both periods, all patients were screened for MRSA and two drug-resistant Acinetobacter baumannii (2DRA) to detect acquisition of those pathogens in the ICU. For microbiological evaluation, surfaces were selected for sampling by contact plates before/after manual cleaning and after PX-UV. After overnight incubation, colonies on the plates were counted. Results The incidence of newly acquired MRSA declined over time (1.40 per 1,000 patient-days in the baseline period to 0.95 in the intervention period, relative risk (RR): 0.68, 95% confidence interval (CI): 0.12–3.70). The incidence of newly acquired 2DRA further declined (4.91 to 1.90, RR: 0.39, 95% CI: 0.13–1.18). Notably, no new acquisition of 2DRA was observed since August 2018 for more than 7 months, not only in the ICU but also throughout the hospital. The total count of colonies in the sampling of 140 sites after 17 patient discharges were 3,540 (before manual cleaning), 669 (after manual cleaning, before PX-UV) and 261 (after PX-UV). The percent reduction of microbiological burden by manual cleaning was 81%, but a further 61% reduction was achieved by PX-UV. Conclusion PX-UV is effective in further reducing the microbial burden even after through manual cleaning, which presumably led to termination of transmission of 2DRA in our hospital. The effectiveness of PX-UV in controlling MDROs in the non-US healthcare settings is suggested. Disclosures All authors: No reported disclosures.

Clinical Characteristics, Acute Complications, and Neurologic Outcomes of Salmonella Meningitis in Saudi Infants and Children

2019 ◽  
Vol 15 (01) ◽  
pp. 031-038
Author(s):  
Sarah Alsubaie ◽  
Abdulkarim Alrabiaah
Keyword(s):  
Age Of Onset ◽  
Sinus Thrombosis ◽  
Neurological Complications ◽  
Infants And Children ◽  
University Hospital ◽  
Neurologic Complications ◽  
Neurodevelopmental Outcomes ◽  
Acute Complications ◽  
Salmonella Meningitis

Abstract Objective This study aimed to clarify the clinical presentations, acute complications, and long-term sequelae of Salmonella meningitis in Saudi infants and children. Methods This retrospective study, conducted from 1999 to 2016, evaluated the neurological complications and long-term outcomes of children 14 years of age and younger diagnosed with Salmonella meningitis at King Khalid University Hospital. All affected children had 3 years of follow-up to assess neurologic complications and mortality. Results Invasive Salmonella infection occurred in 141 patients. Of those, 14 (10%) had meningitis. The median age of onset of infection was 4.7 months. The most frequent symptoms at presentation included fever (100%), seizures (71%), diarrhea, and vomiting (43%). Nontyphoidal Salmonella species were isolated in all (but one) cerebrospinal fluid samples. Relapse occurred in four patients owing to inadequate antibiotic duration, although the organisms were susceptible to ceftriaxone. The majority of patients (86%) developed acute neurologic complications, including subdural empyema and multiple cerebral infarcts (57%), hydrocephalus (36%), ventriculitis (29%), and cerebral venous sinus thrombosis (21%). Four patients (28.5%) died due to Salmonella meningitis complications. Four patients survived with full recovery. Six patients (60%) had long-term neurologic complications. Hydrocephalus, cerebral palsy, developmental delay, and epilepsy occurred in five, four, three, and three patients, respectively. Conclusion Salmonella meningitis results in significant mortality and adverse neurodevelopmental outcomes. The probability of relapse after an apparent recovery should be considered. Consensus on antibiotic treatment for Salmonella meningitis is needed.

Spinal and Intracranial Epidural Abscess, and Subdural Empyema

2017 ◽  
Author(s):  
Tyler R. West ◽  
Kelly J Baldwin
Keyword(s):  
Epidural Abscess ◽  
Normal Skin ◽  
Cord Compression ◽  
Subdural Empyema ◽  
Spinal Epidural Abscess ◽  
Neurosurgical Procedures ◽  
Direct Extension ◽  
Adjacent Structures ◽  
Skin Flora ◽  
Hematogenous Seeding

A spinal epidural abscess is an infection that resides in the epidural space of the spinal canal, and most commonly occurs from hematogenous seeding or direct extension from adjacent structures. Normal skin flora such as Staphylococcus and Streptococcus spp are the most common organisms to cause an epidural abscess, typically when host immunity is compromised or due to barrier disruption. The clinical presentation is heterogeneous, but often will progress over time to spinal cord compression. Intracranial epidural abscess and subdural empyema occur within the skull and are frequently spread via direct extension of infections from contiguous structures or as complications from neurosurgical procedures. Prompt diagnosis and treatment is essential for improving morbidity and mortality.

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