A case of rhinogenic intracranial complications by frontal sinusitis

Abstract

Intracranial complications of rhinosinusitis are conditions in which inflammation of the paranasal sinuses spills over into the cranium, and even today it can be fatal. We herein report a case of intracranial complication arising from frontal sinusitis that resulted in extensive cerebral venous sinus thrombosis. The patient was an 82-year-old woman who was referred to our department because of left periorbital erythema. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed left frontal sinusitis and associated left superior ophthalmic vein thrombosis and cerebral venous sinus thrombosis. In addition to receiving systemic antibiotic therapy, the patient consulted the neurosurgery department and started continuous heparin administration, but there was no improvement. Endoscopic sinus surgery (ESS) was performed for drainage of the frontal sinus, and the patient responded well and was discharged from the hospital without sequelae. The patient had been treated with glucocorticoids for rheumatoid arthritis for a long time, which may have increased the risk of intracranial thrombosis. In cases of severe infection in patients receiving long-term steroid therapy, it is important to keep in mind the risk of thrombosis and to promptly collaborate with other departments for nasal intracranial complications so as not to miss the opportunity to perform surgical treatment of sinus drainage.