Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome (original) (raw)
Related papers
Case Reports in Infectious Diseases, 2020
A 27-year-old female patient initially presented with fever, myalgia, sore throat that progressed to multifocal pneumonia, and cerebral sinus venous thrombosis. A combination of upper respiratory symptoms with tooth infection, positive blood culture for Fusobacterium nucleatum, computed tomography (CT) chest finding of multifocal pneumonia, and magnetic resonance imaging (MRI) finding of internal jugular vein thrombosis (IJVT) and cerebral venous sinus thrombosis (CVST) suggested Lemierre syndrome. The patient was managed with fluids, antibiotics, and anticoagulants. The patient survived and discharged from the hospital. The patient’s symptoms improved at 2 months of follow-up.
Non-Traumatic Pneumocephalus and Sub-Dural Empyema as a Complication of Chronic Sinusitis
Cureus, 2019
Infectious sinusitis is extremely common in children, and persistent infection can lead to many complications. The most dangerous and commonly reported complications are intracranial. These intracranial complications include pneumocephalus, cerebral abscess, subdural empyema, meningitis, cellulitis, orbital abscess, and cavernous sinus thrombosis. Pneumocephalus is the presence of air in the cranium and sometimes it can lead to intracranial infection and localized pus collection in the potential space between meninges. Herein, we report a case of a 12-year-old girl who presented to a pediatric emergency in a confused and disoriented state. The cerebrospinal fluid (CSF) analysis provided a picture of bacterial meningitis, but her CT scan showed pneumocephalus and subdural empyema. This case report will help clinicians overcome this diagnostic challenge using the appropriate imaging and treatment modalities to prevent neurological sequelae.
Extensive subgaleal abscess and epidural empyema in a patient with acute frontal sinusitis
Journal of the Formosan Medical Association = Taiwan yi zhi, 2003
Acute frontal sinusitis can be a serious condition because of its potential life-threatening complications. These complications, including spread of infection to the frontal bone and intracranially, require prompt diagnosis and intervention to avoid morbidity and mortality. We report a case of acute frontal sinusitis in a 16-year-old girl who presented with fever, severe headache, and vomiting of 3 days' duration. Generalized fluctuant swelling of the nasal root, and bilateral supraorbital and frontoparietal regions was noted. Computed tomography (CT) demonstrated left pansinusitis, extensive subgaleal abscess and epidural empyema with osteomyelitis of the frontal bone. External frontoethmoidectomy with mucoperiostectomy were performed. Endoscopic sinus surgery was then conducted for intranasal ethmoidectomy. Intraoperative cultures grew viridans streptococci, coagulase-negative staphylococci and Peptostreptococcus micros. The patient received 3 weeks of treatment with intraveno...
2015
Subdural empyema (SDE) and cerebrovascular accident (CVA) are uncommon life-threatening complications of bacterial meningitis, which require urgent neurosurgical intervention to prevent adverse outcomes. Clinicians must be vigilant of the onset of focal neurologic deficits or seizure activity to establish the diagnosis of SDE. Streptococcus pneumoniae accounts for <1% of pyogenic brain abscesses. This case describes a presentation of community acquired pneumococcal pneumonia in which the diagnosis of SDE with vasculitis induced CVA was confounded by concomitant substance abuse and sedation.
International Surgery Journal, 2017
Subdural empyema is a rare complication that causes high morbidity and mortality following sinusitis. Cranial complications should be considered in patients who develop neurological symptoms. These patients need surgery that should be performed by neurological and ear-nose-throat surgeons working together. A 14-year-old girl developed aphasia and hemiparesis from retrograde thrombophlebitis following sinusitis and we planned a two-stage surgery for the patient. In the first step, we drained the empyema by a craniotomy and functional endoscopic sinus surgery. In the second step, we drained a mature abscess. The purpose of this paper is to review the surgical and clinical management of intracranial complications from sinonasal infections.
Neurosurgery, 1999
OBJECTIVE A N D IMPORTANCE: Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal con ditions. The occurrence of all three in a single patient has not previously been described. W e present such a case occurring in a young, otherwise healthy man. C LIN IC A L PRESENTATION: A 26-year-old man w ith a rem ote history of sinusitis developed rapidly progressive headache, fever, right eye pain, swelling, proptosis, and visual im pairm ent. M agnetic resonance imaging demonstrated diffuse pansinusitis, including sphenoid sinusitis, and ex tension of inflam m ation and infection into the adjacent cavernous si nuses, pituitary gland, and posterior fossa. INTERVENTIO N: Urgent drainage of the ethmoid and maxillary sinuses was performed; pus was not identified. The patient continued to deteriorate clinically with worsening of visual acuity. Computed tomography of the head performed the next day revealed worsening hydrocephalus and an enlarging posterior fossa subdural empyema. Urgent ventricular drainage and evacuation of the empyema was performed, and subsequently, the patient's clinical course improved. The microbiology results revealed alpha hemolytic streptococcus and coagulase-negative staphylococcus species. The patient survived but during the follow-up period had a blind right eye and pituitary insufficiency. C O N C L U S IO N : Paranasal sinusitis can have devastating intracranial se quelae. Involvem ent of the adjacent pituitary gland and cavernous sinuses can result in serious neurological m orbidity or m ortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvem ent. A high index of suspicion and aggres sive medical and surgical treatm ent are crucial for patient survival, but the m orbidity rate remains high. O u r patient survived but lost anterior pituitary function and vision in his right eye.
Frontal sinusitis complicated by a brain abscess and subdural empyema
Radiology Case Reports
A 49-year-old male was brought to the Emergency Department after being found unresponsive. The patient had multiple seizures and was intubated in the prehospital setting. A computed tomography scan showed bilateral paranasal sinus disease, and magnetic resonance imaging showed a right frontal abscess and subdural empyema. Neurosurgery took the patient to the operating room, performed a craniotomy, and drained a large amount of purulent fluid. He was subsequently discharged for acute rehabilitation. Clinicians should consider complicated frontal sinusitis, especially in the undifferentiated patient presenting with neurologic deficits and signs or symptoms of sinus disease.
Intracranial Complications of Sinusitis: A 15-Year Review of 39 Cases
Ear, Nose & Throat Journal, 2002
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 th...