Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T03:54:26.307Z Has data issue: false hasContentIssue false
  • English
  • Français

Sinogenic intracranial complications

Published online by Cambridge University Press:  29 June 2007

Bharath Singh ,
James Van Dellen ,
Shanil Ramjettan  and
Tejprakash J. Maharaj
Bharath Singh*
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, Congella 4013, South Africa.
James Van Dellen
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, Congella 4013, South Africa.
Shanil Ramjettan
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, Congella 4013, South Africa.
Tejprakash J. Maharaj
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, Congella 4013, South Africa.
*
Mr B. Singh, Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, PO Box 17039, Congella 4013, South Africa.
Get access Rights & Permissions [Opens in a new window]

Abstract

Two hundred and nineteen patients, with intracranial complications of sinusitis, are presented. Sinusitis is still a life-threatening condition and if neglected, or mismanaged, can lead to intracranial complications that result in a high mortality and morbidity.

Twenty-two patients had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema. The diagnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, chemistry and culture. The most frequent presenting signs were fever (68 per cent) and headache (54 per cent). The most common localizing neurological sign was hemiparesis (35.5 per cent). Orbital inflammation was present in 41.5 per cent of patients.

Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, performed within 12 hours of admission. In patients with meningitis, the surgery entailed surgery of the sinus disease only. In patients with subdural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approach, immediately after drainage of the intracranial collection of pus, was carried out.

There were 35 deaths (16 per cent). The highest mortality rate was recorded in patients with meningitis (45 per cent) followed by brain abscess (19 per cent) and subdural empyema (11 per cent). Despite advances in medicine, i.e. antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial complications has remained significant. This can only be eliminated through education. This paper emphasizes to younger generations of otolaryngologists and primary care physicians that sinusitis is a serious disease and there is no place for delay or complacency when managing such patients.

Keywords

Sinusitiscomplicationsintracranial
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 10 , October 1995 , pp. 945 - 950
Copyright
Copyright © JLO (1984) Limited 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ballantine, H. T., White, J. C. (1953) Influence of antibiotics on therapy and mortality. New England Journal of Medicine 248: 248–14.CrossRefGoogle Scholar
Bannister, G., Williams, B., Smith, S. (1981) The treatment of subdural empyema. Journal of Neurosurgery 55: 55–82.CrossRefGoogle ScholarPubMed
Beckhuis, G. J., Taylor, M. (1969) Ear and sinus aspects of intracranial suppuration diseases. In Cranial and Intracranial Suppuration, (Gurdjian, E. S., ed.). Charles, C. Thomas, Springfield, II.Google Scholar
Bhandari, Y. S., Sarkari, N. B. (1970) Subdural empyema: a review of 37 cases. Journal of Neurosurgery 32: 32–35.CrossRefGoogle ScholarPubMed
Buchheit, W. A., Ronis, M. L., Liebman, E. (1970) Brain abscesses complicating head and neck infections. Transactions of the American Academy of Ophthalmology and Otolaryngology 84: 84–548.Google Scholar
Carey, M., Chou, S., French, L. (1971) Long-term neurological residua in patients surviving brain abscess with surgery. Journal of Neurosurgery 34: 34–652.CrossRefGoogle ScholarPubMed
Clain, A. (1973) Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery, (Clain, A., ed.), 17th Edition, ch. 6, John Wright and Son Ltd, Bristol, p 56.Google Scholar
Clayman, G. L., Adams, G. L., Paugh, D. R., Koopman, C. F. (1991) Intracranial complications of paranasal sinusitis: a combined institutional review. Laryngoscope 101: 101–234.CrossRefGoogle ScholarPubMed
Courville, C. B. (1944) Subdural empyema secondary to purulent frontal sinusitis. Archives of Otolaryngology, Head and Neck Surgery 39: 39–211.CrossRefGoogle Scholar
Courville, C. B., Rosenvold, L. K. (1938) Intracranial complications of infections of nasal cavities and accessory sinus. Archives of Otolaryngology, Head and Neck Surgery 27: 692–731.CrossRefGoogle Scholar
Farmer, T. W., Wise, G. R. (1973) Subdural empyema in infants, children and adults. Neurology 23: 23–254.CrossRefGoogle ScholarPubMed
Garfield, J. (1969) Management of supratentorial intracranial abscess: a review of 200 cases. British Medical Journal 2: 2–7.Google ScholarPubMed
Hitchcock, E., Andreadis, A. (1964) Subdural empyema: a review of 29 cases. Journal of Neurology, Neurosurgery and Psychiatry 27: 27–422.CrossRefGoogle ScholarPubMed
Hoyt, D. J., Fisher, S. R. (1991) Otolaryngological management of patients with subdural empyema. Laryngoscope 101: 101–20.CrossRefGoogle ScholarPubMed
Jooma, O. V., Pennybacker, J. B., Tutton, G. K. (1951) Brain abscess: aspiration, drainage or excision. Journal of Neurology, Neurosurgery and Psychiatry 14: 14–308.CrossRefGoogle ScholarPubMed
Kaufman, D. M., Miller, M. H., Steinbigel, N. H. (1975) Subdural empyema: analysis of 17 recent cases and review of the literature. Medicine 54: 54–485.CrossRefGoogle ScholarPubMed
Kornblut, A. (1972) Cerebral abscess - a recurrent otological problem. Laryngoscope 82: 1541–1586.CrossRefGoogle Scholar
Kubik, C. S., Adams, R. D. (1943) Subdural empyema. Brain 66: 66–18.CrossRefGoogle Scholar
Loeser, E., Sheinberg, L. (1957) Brain abscesses: a review of 99 cases. Neurology 7: 7–601.CrossRefGoogle Scholar
Ray, B. S., Parsons, H. (1943) Subdural abscess complicating frontal sinusitis. Archives of Otolaryngology (Chicago) 37: 37–536.Google Scholar
Sable, N. S., Hengerer, A., Powell, K. R. (1984) Acute frontal sinusitis with intracranial complications. Pediatric Infectious Disease 3: 3–58.Google ScholarPubMed
Schiller, F., Cairns, H., Russell, D. S. (1948) The treatment of purulent pachymeningitis and subdural suppuration with special reference to penicillin. Journal of Neurology, Neurosurgery and Psychiatry 11: 11–143.CrossRefGoogle ScholarPubMed
Wood, P. H. (1952) Diffuse subdural suppuration. Journal of Laryngology and Otology 66: 66–496.CrossRefGoogle ScholarPubMed
Wright, R. L., Ballantine, H. T. (1967) Management of brain abscess in children and adolescents. American Journal of Disease of Children 114: 114–113.Google ScholarPubMed