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 Intracranial Complications of Sinusitis: A 15-Year Review of 39 Cases

2002 ◽  
Vol 81 (9) ◽  
pp. 636-644 ◽  
Author(s):  
Ramzi T. Younis ◽  
Rande H. Lazar ◽  
Vinod K. Anand
Keyword(s):  
Sinus Thrombosis ◽  
Medical Center ◽  
Surgical Techniques ◽  
Computer Assisted Surgery ◽  
Computer Assisted ◽  
Sagittal Sinus ◽  
Mississippi Medical ◽  
Intracranial Complications ◽  
Orbital Complications ◽  
Outcomes Management

Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk of serious and potentially fatal complications. We examined the charts of 82 patients who had been admitted to the University of Mississippi Medical Center between Jan. 1, 1985, and Dec. 31, 1999, for treatment of complications of sinusitis. Of these 82 patients, 43 had orbital complications and 39 had intracranial complications. In this article, we describe our findings in those patients who had intracranial complications (our findings in patients with orbital complications will be reported in a future article). The most common intracranial complication was meningitis; others were epidural abscess, subdural abscess, intracerebral abscess, Pott's puffy tumor, and superior sagittal sinus thrombosis. Most patients with meningitis were treated with drug therapy only; patients with abscesses were generally treated with intravenous antibiotics and drainage of the affected sinus and the abscess. Advancements in antibiotic therapy, endoscopic surgery, imaging studies, and computer-assisted surgery have helped improve outcomes. Management of these patients should be undertaken immediately and is best achieved via a multidisciplinary approach, involving the otolaryngologist, neurosurgeon, radiologist, anesthesiologist, infection disease specialist, pediatrician, internist, and others.

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.

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 Cerebral Venous Sinus Thrombosis with an Intracranial Haemorrhage: A Case Report

2019 ◽  
Vol 7 (6) ◽  
pp. 1029-1031 ◽  
Author(s):  
Abdullah M. Al Zahrani ◽  
Reem Al Sheikh
Keyword(s):  
Sinus Thrombosis ◽  
Signs And Symptoms ◽  
Cerebral Venous Sinus Thrombosis ◽  
Pregnant Female ◽  
Venous Sinus ◽  
Diagnostic Challenge ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Life Threatening ◽  
Acute Headache

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a rare, life-threatening disorder. It has an annual incidence of approximately two to four per million people per year. Nearly 70–80% of all cases of CVST are located in the superior sagittal sinus (SSS). CVST presents a diagnostic challenge due to different presentations. CASE PRESENTATION: We describe the case of a young pregnant female who presented to the emergency room with an acute headache attributed to multifactorial causes. CONCLUSION: This report highlights the importance of including CVST in the differential diagnosis when treating a pregnant female with headaches. Although the symptoms of CVST are varied, the most common occlusion is in the SSS. In such cases, the patient may present with signs and symptoms that include headaches, intracranial hypertension and papilloedemas.

Complications of Acute Sinusitis in Children

2005 ◽  
Vol 133 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Lance E. Oxford ◽  
John McClay
Keyword(s):  
Sinus Thrombosis ◽  
Tertiary Care ◽  
Outcome Data ◽  
Acute Sinusitis ◽  
Neurological Deficits ◽  
Ocular Motility ◽  
Duration Of Symptoms ◽  
Streptococcus Milleri ◽  
Intracranial Complications ◽  
Orbital Complications

OBJECTIVE: To review the demographic, microbiologic, and outcome data for children with complications of acute sinusitis. STUDY DESIGN AND SETTING: Retrospective review of children admitted with complications of acute sinusitis from January 1995 to July 2002 to a tertiary care children's hospital. RESULTS: One hundred four patients were reviewed with the following complications: orbital cellullitis (51), orbital abscesses (44), epidural empyemas (7), subdural empyemas (6), intracerebral abscesses (2), meningitis (2), cavernous sinus thrombosis (1), and Pott's puffy tumors (3). Sixty-six percent were males ( P < 0.001), and 64.4% presented from November to March ( P < 0.001). Patients with isolated orbital complications were younger than patients with intracranial complications (mean, 6.5 versus 12.3 years), had a shorter stay (mean, 4.2 versus 16.6 days), and had shorter duration of symptoms (mean, 5.4 versus 14.3 days; all P < 0.0001). Complete resolution was documented for 54/55 patients with restricted ocular motility, 7/8 with visual loss, 3/3 patients with a nonreactive pupil, 7/7 with neurological deficits, and 2/4 with seizures. The most common organism isolated was Streptococcus milleri (11/36 patients with surgical cultures). No mortalities occurred, and persistent morbidity occurred in 4 patients (3.8%). CONCLUSIONS: Despite significant deficits on presentation, permanent morbidity was low. Streptococcus milleri is a common pathogen with complications of sinusitis in children.

scholarly journals Outcomes of endoscopic sinus surgery for sinusitis-induced intracranial abscess in patients undergoing neurosurgery

2019 ◽  
Vol 47 (2) ◽  
pp. E12 ◽  
Author(s):  
Megumi Koizumi ◽  
Miho Ishimaru ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Tatsuya Yamasoba ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Length Of Stay ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Neurosurgical Procedures ◽  
Fungal Sinusitis ◽  
Intracranial Abscess ◽  
Diagnosis Procedure Combination ◽  
Intracranial Complications ◽  
Orbital Complications

OBJECTIVEAlthough sinusitis-induced intracranial complications rarely occur in the current era of antibiotics, they can induce neurological symptoms or death. The authors of this study investigated the association between endoscopic sinus surgery (ESS) and outcomes in patients who had undergone neurosurgical procedures for sinusitis-induced intracranial abscess.METHODSThe authors obtained data on patients with sinusitis-induced intracranial abscess from the Japanese Diagnosis Procedure Combination inpatient data for the period from 2010 to 2017. They excluded patients with fungal sinusitis, orbital complications, immunodeficiency, and malignant disease. They also excluded patients who had received antifungal agents, chemotherapy, immunosuppressants, and antidiabetic drugs. Eligible patients were divided into those with and those without neurosurgical procedures. Propensity score–adjusted regression analyses were performed to examine the association between ESS within the same hospitalization and outcomes (mortality, blood transfusion, readmission, revision neurosurgery, and length of stay).RESULTSOf the 552 potentially eligible patients, 255 were treated with neurosurgical procedures, including 104 who underwent ESS within the same hospitalization and 151 who did not. ESS was not significantly associated with mortality (OR 0.54, 95% CI 0.05–5.81, p = 0.61), blood transfusion (OR 1.95, 95% CI 0.84–4.51, p = 0.12), readmission (OR 0.86, 95% CI 0.34–2.16, p = 0.75), revision neurosurgery (OR 0.65, 95% CI 0.24–1.74, p = 0.39), or length of stay (percent difference −10.8%, 95% CI −24.4% to 5.1%, p = 0.18).CONCLUSIONSThe present study suggests that ESS may not have significant benefits with respect to reducing mortality, blood transfusion, readmission, revision neurosurgery, or length of stay.

scholarly journals Superior sagittal sinus thrombosis in a case of beta thalassaemia major

2017 ◽  
Vol 4 (2) ◽  
pp. 585
Author(s):  
Syed Md Azad ◽  
Anwesha Mukherjee ◽  
Rohit Kapoor ◽  
Rohit Bannerji ◽  
Jaydeb Ray
Keyword(s):  
Clinical Symptoms ◽  
Sinus Thrombosis ◽  
Incidental Finding ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Thalassaemia Major ◽  
Beta Thalassaemia ◽  
Sagittal Sinus ◽  
Life Threatening ◽  
Transfusion Dependency

Patients with beta- thalassaemia major have a wide spectrum of clinical manifestations, from transfusion dependency to asymptomatic anaemia. Some may just have incidental finding of anaemia with splenomegaly during physical examination. Most of them require regular blood transfusion and their haemoglobin is maintained at an acceptable level. However they are at risk for multiple complications such as thrombo-embolic events which may be life threatening. We report here a case of beta- thalassaemia major complicated by cerebral sinus thrombosis, who had minimal clinical symptoms and signs at presentation. This case reiterates the importance of increased vigilance in the clinical management of this vulnerable group of patients. 

Use of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Diagnosis of Sigmoid Sinus Thrombosis

1997 ◽  
Vol 76 (7) ◽  
pp. 436-441 ◽  
Author(s):  
Steven P. Davison ◽  
George W. Facer ◽  
Paul F. McGough ◽  
Thomas V. McCaffrey ◽  
Paul A. Reder
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Sinus Thrombosis ◽  
Imaging Modality ◽  
Sigmoid Sinus ◽  
Resonance Imaging ◽  
Conventional Angiography ◽  
Sagittal Sinus ◽  
Intracranial Complications

Magnetic resonance angiography is an established radiologic technique which is rapidly becoming useful in imaging the head and neck. Currently, this imaging modality is important in the diagnosis of sigmoid sinus thrombosis caused by otologic disease. Since the introduction of antibiotic therapy, the percentage of deaths attributed to intracranial complications from otitic disease has decreased from 2.5 to approximately 0.25% of documented deaths. Also, the incidence of sinus thrombosis within this group has decreased, but it is still a serious and potentially lethal condition. Sinus thrombosis is suspected clinically when mastoid disease progresses, with picket fence fever pattern, chills, headaches and signs of papilledema. Definitive diagnosis is necessary before surgical treatment. The Queckenstedt test is unreliable, computed tomography is better suited for demonstrating thrombosis of the sagittal sinus rather than the sigmoid sinus, and conventional angiography (although it provides excellent visualization) has the hazard of ionizing radiation and requires vessel puncture and the use of intraarterial contrast agents. We present two cases of thrombosis of the sigmoid sinus as an intracranial otologic complication which were diagnosed definitively with magnetic resonance imaging and magnetic resonance angiography. The combination of magnetic resonance imaging, which showed the thrombosis displaying abnormal signal intensity, and magnetic resonance angiography, which demonstrated the absence of flow in the sinus, was an ideal diagnostic tool. For both patients, treatment consisted of mastoidectomy, sigmoid sinus decompression and antibiotics.

scholarly journals Decompressive surgery in malignant dural sinus thrombosis: report of 3 cases and review of the literature

2009 ◽  
Vol 26 (6) ◽  
pp. E5 ◽  
Author(s):  
Luigi A. Lanterna ◽  
Paolo Gritti ◽  
Ornella Manara ◽  
Gianluca Grimod ◽  
Gianmario Bortolotti ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Clinical Signs ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Brain Herniation ◽  
Sagittal Sinus ◽  
Clot Removal ◽  
Life Threatening ◽  
Middle Aged Adults

Cerebral venous and dural sinus thrombosis (CVDST) is a rare cause of stroke in young and middle-aged adults. When the clinical course is complicated by uncontrollable intracranial hypertension and brainstem compression due to edema or cerebral hemorrhage, the prognosis is poor. The authors evaluated the therapeutic role of surgical decompression in patients with clinical signs of impending herniation. Cerebral venous and dural sinus thrombosis complicated by impending brain herniation a very rare, life-threatening but potentially treatable clinical condition. Three patients with pupillary signs of transtentorial herniation due to brain edema and hemorrhage caused by CVDST (superior sagittal sinus in 1 patient and transverse and sigmoid sinus in 2 patients) were treated surgically. The intervention consisted of clot removal, infarcted tissue resection, and frontotemporoparietooccipital craniectomy with duraplasty. According to the Glasgow Outcome Scale, 2 patients were classified as having good recovery and 1, moderate disability. The results of neuropsychological assessment were normal in 2 patients and demonstrated a partial neuropsychological deficit (neglect) in the other. Surgery may be indicated in selected patients with CVDST whose condition is deteriorating because of intractable intracranial hypertension and impending brain herniation.

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