2017 Volume 45 Issue 3 Pages 227-232
Acute sinusitis can lead to intracranial complications, such as brain abscess, subdural or epidural empyema, meningitis, and cavernous sinus thrombosis, and to orbital complications, such as orbital cellulitis and orbital subperiosteal abscess. We encountered a case of bacterial meningitis that arose from frontal sinusitis. The patient was a 13-year-old-girl who presented with fever, headache, diplopia, and some neck stiffness and right upper limb numbness. She was referred to our department when blood tests revealed C-reactive protein elevation. Head computed tomography and cerebrospinal fluid examination were performed, and the results led a diagnosis of bacterial meningitis and subdural abscess; staining of the cerebrospinal fluid revealed gram-positive cocci. We began treatment by administering ceftriaxone and vancomycin, but when Streptococcus pneumoniae was isolated from the spinal fluid and blood, we switched to ampicillin because of the sensitivity of S. pneumoniae to this antimicrobial agent. Head magnetic resonance imaging was performed, and a semicircular subdural abscess around the fornix was seen. Because the patient’s numbness seemed to result from pressure caused by this abscess, we performed burr-hole drainage. The antibiotics were administered for a total of 6 weeks, and the patient improved without sequela. Pneumococcal serotype 20 was identified in the final culture. Intracranial complications of acute sinusitis may result in neurologic sequela or be fatal; hence, early diagnosis and treatment are critical.
