2016 Volume 109 Issue 7 Pages 487-492
Recently, the mortality rate from intracranial complications secondary to bacterial infection of the paranasal sinuses has decreased, because of the availability of effective antibiotic treatment. However, the complications of acute bacterial rhinosinusitis still pose a potentially life-threatening problem. Long-term antibiotic therapy together with prompt endoscopic surgery is considered suitable for the treatment of this disease. Herein, we report the case of a patient who developed intracranial complications secondary to acute rhinosinusitis.
An 18-year-old male complained of nasal obstruction and purulent nasal discharge. About one month later, he presented at the neurological department with severe frontal headache, high fever and nausea, and was suspected as having acute meningitis. He was immediately hospitalized and treated with antibiotics. Nine days later, the patient developed paresis and sensory disturbance of the left lower extremity. Because computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of paranasal sinus opacification and a subdural soft-density lesion, the patient was referred to the Department of Otolaryngology of our hospital. Endoscopic sinus surgery with surgical drainage of the subdural abscess was performed.
After the surgical procedure, the headache, paresis and sensory disturbance of the left lower extremity resolved completely. However, 43 days later, lower right quadrantanopsia was observed, and CT revealed recurrence of the abscess in the occipital region. Surgical drainage of the subdural abscess was performed again. After administration of a long course of antibiotics again, the patient was discharged 55 days postoperatively.
We encountered a case of subdural abscess complicating sinusitis. Both the subdural abscess and sinusitis improved with aggressive antibiotic and surgical treatment, while the neurosurgery department confirmed that there were no signs of neurologic deficits.
