Sinusitis-associated intracranial complications

Sinusitis-associated intracranial complications

Acute and chronic inflammation of the nasal cavity and paranasal sinuses can cause a number of orbital and intracranial complications, which often lead to loss of vision, and sometimes the death of the patient.

Among rhinogenous intracranial complications are more common complications of nasal trauma, especially surgical, face and abrasions of the nose.

In inflammatory diseases of the paranasal sinuses most frequent source of complications is the frontal sinus, which accounts for more than 50% of all intracranial complications, less ethmoidal labyrinth, maxillary sinus and the main. Most typical intracranial complications:

• Epidural abscess
• Subdural abscess
• Suppurative thrombophlebitis
• Bacterial meningitis
• Brain abscess (lobar, cerebellar)
• Arachnoiditis (hydromeningitis)

Subdural abscess is usually distributed over the frontal, parietal and the upper part of the temporal lobe of the brain, if these changes can be attributed to destruction, for example, the frontal sinus.

Diagnosis extradurally abscess often performed during operation. Common symptoms rhinogenous brain abscess and purulent meningitis are the same as that of a otogennyh intracranial complications. Local symptoms are characterized by the phenomena of the damage of the anterior cranial fossa.

Abscess in the frontal lobe of the brain are often not manifested and recognized only at postmortem examination. However, may experience mental changes, manifested depression, inhibition, or conversely, excitation, euphoria, inappropriate behavior. When left-sided localization of the abscess observed motor aphasia, agraphia. Anosmia occurs, but not often. More likely to be epileptic seizures, sometimes contralateral paresis and paralysis.

Direct confluence of veins from the upper part of the nasal cavity and paranasal sinuses in the longitudinal sinus of the dura mater may cause the spread of the inflammatory process and cause phlebitis longitudinal sinus. When engaging in inflammatory venous spongy substance of the frontal bone and veins of the dura mater may be formed subperiosteal and extradural abscess in the frontal region.

The consequence of thrombosis, cavernous sinus congestion are in the form of edema of the eyelids and conjunctiva of the eye, protrusion of his blindness, and, finally, diffuse purulent meningitis. Outcome of thrombophlebitis can be Pius.

Brain magnetic resonance imaging (MRI) performed for suspected sinusitis-associated intracranial complications.

Recoveries in the longitudinal and thrombophlebitis cavernous sinus dural dopenitsillinovy a period of almost not observed. Currently under intensive treatment with antibiotics in combination with surgery improved prognosis.

Preventive measures aimed at early treatment of inflammation of the paranasal sinuses. With suspected intracranial complication (abscess of the frontal lobe of the brain, or meningitis) is necessary to make immediate radical operation, removing or draining the main source of infection. The surgical treatment of complicated cases of inflammatory diseases of the paranasal sinuses favorable results obtained from the use of preoperative and postoperative combined therapy sulfanilamidnymi drugs and antibiotics.

Rhinogenous arachnoiditis occurs as a result of inflammation in the paranasal sinuses or may be a consequence of suffering a purulent meningitis, brain abscess. In the first case of arachnoiditis caused by low virulent microbes or toxins. Arachnoiditis occurs in the form of adhesive (adhesive) or cystic process, but rhinogenous arachnoiditis is characteristic of most atrophic form.

Unlike otogenic arachnoiditis, rhinogenous arachnoiditis noted more frequently in the anterior cranial fossa, optohiazmalnoy area and much less frequently in the posterior fossa. Along with this limited form rhinogenous arachnoiditis observed diffuse form of arachnoiditis (basal or convexital arachnoiditis). There are acute (fast-growing increased intracranial pressure) and chronic (tumor) form.

With the damage of chiasmal frequent atrophic changes in the optic nerves, olfactory bulbs of nerves with the progressive decline in vision (sometimes to the point of blindness), and anosmia. Changes in cerebrospinal fluid may be missing (except for increasing pressure) or expressed in a slight CSF pleocytosis, a moderate increase in protein content or even poverty albumin. Along with a headache may be observed lesion III, IV and V pairs of cranial nerves.