Multiple Intracranial Complications of Pansinusitis in Children

Overview

Intracranial complications of sinusitis at the child age are rare, but their consequences may be fatal. The aim of the investigation was to present clinical symptoms with three case reports as well as microbiological findings, diagnostics and present therapeutic procedures of intracranial complications. The authors describe the cases of three boys at the age of 10, 16 and 16.5 years, hospitalized at the Intensive Care and Resuscitation Unit of the Children Clinic in Olomouc. After admission into the hospital the children suffered from nonspecific clinical signs: headache, fever, nausea and vomiting. Unilateral pansinusitis was determined during CT examination in all three patients. The intracranial complications of sinusitis included meningitis, subdural and epidural empyema and abscesses of the brain. Two patients suffered from multiple complications. The cultivation examination demonstrated mixed bacterial flora.

Mixed aerobic and anaerobic flora was present in one boy. CT examination of the brain with a contrast agent and MR of the brain were made repeatedly in all three boys. All of them were treated with high doses of antibiotics and drainage of sinuses and purulent intracranial foci. One patient died under the picture of multiorgan failure and the other two patients were dismissed without clinical symptoms of permanent consequences.

Nonspecific clinical signs of purulent intracranial complications of sinusitis frequently result in their late diagnosis. Suspected complications should be the indication for CT examination of the cavities, which should be supplemented by CT or MR examination of the brain. Early diagnosis and correctly applied therapy of intracranial complications decrease morbidity and mortality.

Key words:
sinusitis, intracranial complications, CT examination, MR examination