Identifying and managing intracranial complications of sinusitis in children: A retrospective series

Caitlin W. Hicks, Joseph G. Weber, Janet R. Reid, Manikum Moodley

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Of patients admitted to hospital with sinusitis, about 3% have an intracranial complication. We describe the clinical features, laboratory data, imaging findings, and outcomes of pediatric patients with intracranial complications of sinusitis. METHODS: A retrospective chart review of all pediatric patients <21 years of age admitted for intracranial complications of sinusitis to a tertiary hospital over a 10-year period. RESULTS: A total of 13 patients with a mean age of 13.3 ± 3.7 years presented with headache (92%), fever (85%), nausea/vomiting (62%), sinus tenderness (31%), and lethargy (23%). Physical examination findings included Pott puffy tumor (46%), orbital cellulitis (46%), altered level of consciousness (46%), new-onset seizure (31%), hemiparesis (23%), nuchal rigidity (23%), visual disturbance (23%), and slurred speech (15%). Computed tomography and magnetic resonance imaging demonstrated 16 instances of epidural and subdural empyema, and 1 brain abscess. One child had sagittal sinus thrombosis. CONCLUSIONS: Our findings suggest that acute sinusitis in combination with severe intractable headache, varying degrees of altered level of consciousness, focal neurologic deficits, and/or signs of meningeal irritation should raise clinical suspicion for potential intracranial complications of sinusitis. These signs and symptoms should prompt early and aggressive evaluation and management, including neuroimaging studies, neurologic and otolaryngologic consultations, and intravenous antibiotics.

Original languageEnglish (US)
Pages (from-to)222-226
Number of pages5
JournalPediatric Infectious Disease Journal
Volume30
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

Keywords

  • empyema
  • osteomyelitis
  • sinusitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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