Intracranial Complications of Paranasal Sinusitis in Children: A Case Report and Review of Literature

Introduction: Intracranial complications of paranasal sinusitis(ICPS) carry the potential for significant morbidity and mortality. ICPS have become rare due to widespread and early use of antibiotics. ICPS have been reported in 0.5% to 24% of patients hospitalized with sinusitis, with a 3% incidence in pediatric admissions with sinusitis. Potentially life-threatening ICPS include subdural empyema, epidural and intracerebral abscess, meningitis, and sinus thrombosis. Meningitis is the most common intracranial complication of sinusitis. Also paranasal sinusitis can cause orbital cellulitis. In this case report we aimed to present findings of radiological imaging of a patient with paranasal sinusitis causing orbital cellulitis, epidural abscess, menengitis and superior sagittal sinus thrombosis.

Case: An 11-year-old female patient admitted to our eye diseases clinic with complaints of swelling and redness in the right eye. Periorbital edema, conjunctival hyperemia and chemosis were observed. Limitation was observed in extraocular muscles in the patient with severe pain and high fever. Paranasal sinusitis and right orbital extraconeal subperiosteal abscess were observed in computerized tomography image of the patient. Orbital magnetic resonance imaging (MRI) and contrast enhanced brain MRI were performed. Pansinusitis, frontal epidural abscess, exophtalmus because of an intraorbital, extraconeal abscess, superior sagittal sinus thrombosis and frontal menengitis were observed in MRI. Diffusion restriction was observed in frontal and orbital abscess in the diffusion-weighted sequences.

Conclusion: Orbital complications of sinusitis should further elevate suspicion because they frequently coexist with intracranial complications. Early imaging is critical to establish diagnosis, MRI is most sensitive imaging technique to diagnose complications.

Keywords: Sinusitis, Intracranial complications, Orbital cellulitis, Epidural abscess, Sinus thrombosis.