Sinogenic intracranial complications

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.