A Case of Rhinogenic Intracranial Complications Associated with Influenza

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  • Nishida Naoya
    Department of Otolaryngology-Head and Neck Surgery, Ehime University School of Medicine
  • Takahashi Hirotaka
    Department of Otolaryngology-Head and Neck Surgery, Ehime University School of Medicine
  • Gyo Kiyofumi
    Department of Otolaryngology-Head and Neck Surgery, Ehime University School of Medicine

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  • インフルエンザに続発した鼻性頭蓋内合併症例
  • インフルエンザ ニ ゾクハツ シタ ビセイ ズガイ ナイ ガッペイ ショウレイ

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Abstract

<p>We report here a case of rhinogenic intracranial complications associated with influenza. A 14-year-old patient visited the Department of Pediatrics at our hospital with a 38-degree fever and joint pain. He was diagnosed with influenza A and prescribed antivirals; however, five days later, vomiting and left upper limb paralysis occurred, and the patient was emergency transported to our hospital. Cranial magnetic resonance imaging (MRI) was conducted, and a signal was detected in the right frontal cortex on FLAIR imaging. The patient was subsequently diagnosed with influenza encephalopathy and prescribed Peramivir, Edaravone, and Glycerol, and received a combination of steroid pulse therapy and antibiotics. Although his fever had dropped by the next day, his neurological symptoms worsened. The patient was therefore transferred to our hospital’s pediatric department the following day. Based on computed tomography and MRI findings, he was diagnosed with right acute sinusitis and multiple subdural abscess. The multiple nature of his lesions rendered drainage difficult, and so the patient was administered an antibiotic treatment regimen instead. The paranasal sinus was first cleaned via endoscopic sinus surgery under general anesthesia, during which outflow of yellow pus was observed at the opening of the frontal sinus. The nasofrontal fossa was widely opened, and the sinus was washed. Approximately one month after surgery, subdural abscesses had disappeared from imaging findings. The patient was discharged from the hospital two months after surgery. At discharge, relatively high brain dysfunction was observed. In cases with rhinogenic intracranial complications, endoscopic sinus surgery is believed to be minimally invasive. Therefore, performing early surgery and controlling infection sources are important.</p>

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