Infectious Intracranial Complications of Sinusitis, Other Than Meningitis, in Children: 12-Year Review

Abstract

Sinusitis is usually a mild illness in children, but intracranial complications can be life-threatening. We retrospectively reviewed nine cases of intracranial infections secondary to paranasal sinusitis that occurred over a 12-year period, excluding patients with orbital infection only. Cases were highly age- and sex-associated: the median age was 14 years, 89% of patients were >9 years of age, and seven (78%) of the nine patients were male. Symptoms included fever (67%), headache (67%), eye swelling (56%), and seizure (33%). Rhinorrhea was uncommon (22%). Only two patients (22%) had had previous episodes of sinusitis. Staphylococcus aureus and anaerobes were the predominant intracranial isolates. Computed tomography scans of the head showed progression of disease in patients treated with antibiotics alone; surgical drainage was required for all patients. The duration of therapy after surgery was 3–8 weeks. Only one patient (11%) had persistent neurological sequelae. We conclude that (1) teenage males are at greatest risk of developing intracranial infections from sinusitis, (2) common symptoms of sinusitis such as rhinorrhea may not always occur, and (3) outcome can be excellent when a combined medical/surgical approach is used for therapy.