A Case of Intraorbital and Intracranial Rhinogenic Complications

Nario Kazuhiko, Hosoi Hiroshi, Takase Ayako

doi:10.7248/jjrhi.50.127

We report a case of subdural rhinogenic empyema and venous sinus thrombosis (VST) arising from a frontal sinusitis. A 22-year-old man referred for left-side eyelid swelling, right-side hemiplegia, and mild consciousness was found in computed tomography (CT) and magnetic resonance imaging (MRI) to have sinusitis and confirmed subdural empyema and VST. In endoscopic sinus surgery (ESS) under general anesthesia followed by broad-spectrum antibiotic therapy, he was admitted to intensive care at an advanced critical care center. Six hours after ESS, he had bilateral pupil dilation and no light reflex due to cerebral herniation. Hypothermia plus barbiturate therapy helped to prevent brain damage. Osmotic diuretics were administered and anticoagulant heparin therapy continued. Follow-up MRI showed multiple subdural empyema foci, so neurosurgeons drained abscesses in craniotomy. His condition improved gradually postoperatively, leaving no neurological sequelae but ocular left-side movement.<br>We analyzed 34 intracranial rhinogenic complications, including our case, in 34 subjects-26 men and 8 women aged from 10 to 68 years (average: 23.4). Primarily affected paranasal sinus areas were the frontal in 24, ethmoid in 4, sphenoid in 3, maxillary in 1, and idiopathic in 2. Intracranial rhinogenic complications included 21 of subdural empyema, 19 of purulent meningitis, 6 of brain abscess, and 1 of VST, which was in our case. Sinus surgery was done in 27 and neurosurgical drainage in 24. Overall mortality was 8.8%.<br>Intracranial rhinogenic complications thus necessitate immediate diagnosis and treatment.

A Case of Intraorbital and Intracranial Rhinogenic Complications

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