Intracranial complications of rhinosinusitis. A review, typical imaging data and algorithm of management.

STATEMENT OF THE PROBLEM: Intracranial complications of acute bacterial sinusitis remain life-threatening. We aimed to study the current features of the condition--illustration, clinical presentations, risk factors, and define a management strategy.

METHOD OF STUDY: A retrospective study. Review of inpatients treated for meningoencephalitic infections related to sinusitis in a tertiary emergency care center between 1992 and 2005. Data retrieved on age, sex, signs at admission, bacterial findings, sinus involvement, intracranial complications and outcome. We analyzed the relation of bacterial infection to sinus involvement, initial signs of intracranial complications, and risk factors, and reviewed the literature to define a management strategy.

MAIN RESULTS: We retrieved 25 files. Intracranial complications related to sinusitis involved largely men between second and third decade. No risk factor was clearly identified. Frontal and sphenoid sinuses were the most common site involved. Diffuse headache or two-step evolution headache and altered mental status were strongly correlated with meningitis and brain abscess. Empyema was the most common complication. A management algorithm has been defined: computed tomography was early performed to diagnose intracranial collection, and was repeated after 48 h if the clinical course was not favorable. The sinus was always drained by the safest way. Sequelae occurred in 16% of patients. No death occurred with this treatment strategy.

PRINCIPAL CONCLUSION: Intracranial complications of acute sinusitis are exceptional but remain potentially severe and may lead to death. Early imaging data and aggressive management, associating sinus and brain drainage, as well as combined antibiotic therapy, can limit mortality and the incidence of sequelae.