Perform prompt evaluation to exclude complications of chronic sinusitis when a patient presents with ocular or central nervous system signs and symptoms
Perform prompt evaluation to exclude complications of chronic sinusitis when a patient presents with ocular or central nervous system signs and symptoms: Excerpt from Avoiding Common Pediatric Errors
Author:
William Giasi, Jr., MD
What to Do - Gather Appropriate Data
Sinusitis is a common infection that affects children each year. On average, children will experience 5 to 8 viral upper respiratory infections per
year, of which 5% to 13% may be complicated by a secondary bacterial infection of the paranasal sinuses. When a sinus infection goes unrecognized
or untreated, complications may result. Complications of sinusitis include
preseptal, periorbital cellulitis; orbital cellulitis; subperiosteal abscess; and
intracranial complications.
Intracranial complications of sinusitis in order of frequency are epidural abscess, subdural empyema, meningitis, encephalitis, intracerebral brain
abscess, dural sinus thrombophlebitis, and middle cerebral artery ischemia.
Intracranial complications can arise from the spread of septic thrombi or
emboli from the sinus via the valveless diploic veins of the skull base that
penetrate the dura, osteomyelitis of the sinus wall that extends posteriorly,
or an infection that penetrates an existing bony defect in the sinus cavity.
Clinicians should suspect intracranial complications of sinusitis in any
childrenwithsinusitis andanyneurologicfinding,other signsofcomplicated
sinusitis, persistent headache, persistent fever, or nausea/vomiting after antibiotic therapy.
Children with intracranial complications of sinusitis often present with
nonspecific symptoms such as fever, headache, facial mass, or swelling. The
physical exam may be significant for fever, facial mass or edema, abnormal
vision, abnormal extraocular muscle movements, proptosis, or an abnormal
neurologic exam. It is important to recognize that more than half of patients
with intracranial complications of sinusitis may have a normal exam, so the
clinician should maintain a high suspicion.
Several organisms have been identified in the pathogenesis of intracranial complications from sinusitis. They include Streptococcus species (S.
anginosus, S. constellatus, S. intermedius), Staphylococcus aureus, facultative
anaerobes, and gram-negative rods.
The radiological evaluation of a patient for intracranial complications of
sinusitis should either be conducted via a computed tomography scan of the
sinuseswithcontrast,includingcoronalcutsoramagneticresonanceimaging
scan of the brain with contrast. Noncontrast computed tomography scans
lack sensitivity and may be falsely reassuring, leading to a delay in diagnosis.
The treatment of intracranial complications of sinusitis requires a sustained multidisciplinary team approach, including broad antibiotic therapy
and prompt surgical drainage.
Suggested Readings
Adame N, Hedlund G, Byington CL. et al. Sinogenic intracranial empyema in children.
Pediatrics. 2005;116:e461–e467.
American Academy of Pediatrics. Subcommittee on Management of Sinusitis and Committee
on Quality Improvement. Clinical practice guidelines: management of sinusitis. Pediatrics.
2001;108:798–808.
Brook I, Friedman EM, Rodriguez WJ, et al. Complications of sinusitis in children. Pediatrics.
1980;66:568–572.
Bussey MF, Moon RY. Acute sinusitis. Pediatr Rev. 1999;20(4):142.
Germiller JA, Monin DL, Sparano AM, et al. Intracranial complications of sinusitis in children
and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg. 2006;132:969–976.
Nash D, Wald E. Sinusitis. Pediatr Rev. 2001;22(4):111–117.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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