What are the intracranial complications of acute sinusitis?

Updated: Apr 22, 2020
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Intracranial complications may occur as a result of direct extension through the posterior frontal sinus wall or through retrograde thrombophlebitis of the ophthalmic veins. Subdural abscess is the most common intracranial complication, although cerebral abscesses and infarction that result in seizures, focal neurological deficits, and coma may occur. Intracranial complications of sinusitis should be managed surgically with drainage of both the affected sinus and the cranial abscess.

Subdural empyema is a life-threatening infection that may complicate acute sinusitis. Boto et al (2011) reported the case of a previously healthy 10-year-old girl who developed subdural empyema due to Gemella morbillorum infection after an untreated maxillary, ethmoidal, and sphenoidal sinusitis. [24] Despite immediate drainage of the empyema and treatment with broad-spectrum antibiotics, she developed frontal cerebritis and refractory intracranial hypertension, needing urgent decompressive craniectomy. She recovered gradually with slight right-sided hemiparesis and aphasia.

The aforementioned study by Cushen and Francis found that even without antibiotic treatment, the occurrence of brain abscess in association with acute sinusitis is rare. The investigators reported the incidence of brain abscess following acute sinusitis to be 0.11. Moreover, although antibiotic use in acute sinusitis reduced the odds of brain abscess, the number needed to treat to prevent a single case was 19,988. [23]

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