Cases reported "Sinusitis"

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1/73. headache: cortical vein thrombosis and response to anticoagulation.

    Cerebral venous thrombosis (CVT) is being diagnosed more frequently with the use of advanced radiologic imaging. The presentation of CVT includes a wide spectrum of nonspecific symptoms with headache predominating. We present a case with acute, severe headache. The evaluation included a head computed tomography (CT) scan that was normal. The presence of opacified sinuses led to treatment for sinusitis. The patient returned the following day with a generalized tonic-clonic seizure. A magnetic resonance imaging (MRI) study identified an isolated cortical venous thrombosis. This patient was treated with anticonvulsant and anticoagulation therapy. A CVT is an unusual cause of headache and should be considered in patients with atypical presentation or associated seizure, or who are refractory to current therapy. diagnosis may be made with MRI. Resolution and complete recovery are possible with appropriate therapy.
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keywords = headache
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2/73. Severe steroid-dependent asthma with IgG-2 deficiency and recurrent sinusitis: response to treatment with high-dose intravenous immunoglobulin.

    patients with severe asthma pose a dilemma to the physician since the treatment they need, namely high doses of oral steroids, has serious side effects, especially among the pediatric population. Deficiency in one or more of the IgG subclasses has been associated with abnormal pulmonary function, as well as with recurrent sinopulmonary infections in adults and children. In the last years attention has been focused on alternative therapies for these patients. One of these alternatives is the treatment with intravenous immunoglobulin (IVIG). We report an 11-year-old boy with severe asthma since the age of two years and multiple hospital admissions due to asthmatic crisis even more frequent and severe, to the point of needing, in the last year, daily treatment with high doses of oral steroids (20 mg). During six months the patient was given high doses of intravenous immunoglobulin. After one month of treatment a clinical and spirometric improvement was apparent allowing to taper down the oral steroids until their complete substitution by inhaled budesonide (1,600 microg/day). The only side effects noted were severe headaches after gammaglobulin infusions which responded well to oral paracetamol. This improvement was sustained throughout the treatment period, but few weeks after the IVIG was suspended the clinical and spirometric parameters started to worsen again.
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ranking = 0.33333333333333
keywords = headache
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3/73. A possible mechanism of primary ciliary dyskinesia: a case of a segmental defect in ciliary microtubules.

    We report here a 13-year-old woman with cough, sputum and fever. The patient had both chronic sinusitis and bronchitis. Chest X-ray and computed tomographic scan of the chest revealed mucous bronchial filling and bronchiectasia in bronchi of bilateral lower lobes, right middle lobe and left upper lobe. Aerosol inhalation scintigraphy with 99mTechnetium demonstrated delays of the discharged tracer. On the basis of these findings, primary ciliary dyskinesia was suggested. This was confirmed by the findings from nasal biopsy with transmission electron microscopy where all of the microtubules were segmentally defected near the basal body in the cilia. On the basis of these findings, we diagnosed the patient with primary ciliary dyskinesia which may be due, at least in part, to segmental defect of ciliary microtubules.
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ranking = 0.010879200249403
keywords = upper, chest
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4/73. Seven cases of complete and incomplete forms of churg-strauss syndrome not related to leukotriene receptor antagonists.

    BACKGROUND: Various forms of churg-strauss syndrome have been reported in association with the use of leukotriene receptor antagonists in asthmatic patients. OBJECTIVE: Our purpose was to increase awareness that different forms of the churg-strauss syndrome occur in patients not receiving leukotriene modifiers. methods: We searched for all the cases of churg-strauss syndrome that were seen in the University of Rochester Medical Center, new york, in the past 4 years. RESULTS: We identified 7 patients, 6 of whom fulfilled the American College of rheumatology criteria for the classification of churg-strauss syndrome. None of them used leukotriene receptor antagonists. All had asthma and sinus disease. The duration and severity of their asthma varied considerably. In the majority of the patients the features of churg-strauss syndrome became obvious as the systemic corticosteroid dose was being tapered or discontinued, although 3 patients had not been receiving maintenance oral corticosteroids at disease onset. Three patients had positive antineutrophil cytoplasmic antibodies test result (perinuclear pattern). There was histologic documentation of vasculitis in 4 patients. Five of 7 patients responded to high-dose corticosteroid treatment. CONCLUSION: Our 7 cases are similar to the various forms of churg-strauss syndrome that have been reported in association with the leukotriene receptor antagonists. Complete or incomplete forms of this syndrome can become apparent in asthmatic patients as systemic corticosteroids are being tapered but can also occur in patients with mild asthma of short duration who use only inhaled corticosteroids.
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ranking = 0.0022844025288237
keywords = chest
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5/73. Coincidental supraorbital neuralgia and sinusitis.

    headache interpreted as treatment failure may be encountered after FESS or pharmacological treatment for chronic sinusitis. This persistent symptom may lead, even in the presence of minimal sinus disease, to frequent office visits, medical treatment, primary surgery, and revision procedures. A prospective study of patients with a documented history and imaging-verified sinus disease with persistent atypical refractory headache were evaluated. Diagnostic measures included injection of local anesthetic and response to carbamazepine. Severe neuralgia of the supraorbital nerve was identified in 11 patients with chronic sinusitis, treated either medically or surgically before inclusion in the study. Eight of the patients underwent surgery for sinus disease, and five of them had revision surgery because of persisting complaints. All patients responded favorably to the local injection, and eight were treated with carbamazepine. In certain cases, headache in sinusitis patients may be caused or aggravated by supraorbital neuralgia. Sinus disease is possibly a causative factor but conceivably plays the role of a "red herring." This readily diagnosed and treated coexistence may be more prevalent than recognized formerly.
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keywords = headache
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6/73. Endoscopic diagnosis of sarcoidosis in a patient presenting with bilateral exophthalmos and pansinusitis.

    sarcoidosis is a chronic granulomatous disease of unknown etiology. Otolaryngologic and ophthalmologic manifestations occur in 15 to 55% of afflicted individuals, respectively. neck masses, parotid enlargement, and facial nerve palsy are the most common presenting otolaryngologic complaints, while lacrimal gland enlargement, uveitis, and upper eyelid masses often call the attention of the ophthalmologist. biopsy reveals non-caseating granulomas, while the angiotensin converting enzyme (ACE) level may be elevated. We report an unusual case of a patient who presented with severe bilateral exophthalmos as the sole initial complaint. A prior workup included a negative conjunctival biopsy. On magnetic resonance imaging (MRI) and computed tomography (CT), the patient had pansinusitis. Endoscopic ethmoidectomies with tissue analysis revealed sarcoidosis. Further evaluation revealed no evidence of systemic disease, and all symptoms resolved with a course of oral steroids. Thus, nasal endoscopy and biopsy of affected paranasal sinus mucosa may prove a useful adjunct to the diagnosis of sarcoidosis, particularly in atypical cases.
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ranking = 0.0085947977205788
keywords = upper
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7/73. Wegener's granulomatosis triggered by infection?

    Wegener's granulomatosis is a systemic disease of unknown origin, although recent studies suggest that auto-immune mechanisms and infection play a role in the pathogenesis of this disease. Wegener is characterized by a necrotizing vasculitis involving the lungs (pulmonary infiltrates), the upper airways and the kidneys (rapidly progressive glomerulonephritis). We present a case of a male patient admitted because of progressive deterioration of the general condition with weight loss, a unilateral neck mass, unilateral purulent rhinorrea and fever. CT-scan evaluation demonstrated a unilateral expanding mass in the sing-nasal cavity, obliterating the ethmoid complex. MRI revealed signs of intracranial inflammatory reaction and onset of absedation. A malignancy was suspected but a diagnosis of Wegener's granulomatosis was established based on histologic criteria (nasal biopsy) and a positive titer for anti-cytoplasmic antibodies (cANCA). During follow-up, nasal carriage of Staphyloccocus Aureus could be documented. An overview of Wegener's granulomatosis will be provided with emphasis on the potential role of acute infections as a trigger for Wegener's granulomatosis and the head and neck manifestations.
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ranking = 0.0085947977205788
keywords = upper
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8/73. cavernous sinus thrombophlebitis caused by sphenoid sinusitis--report of autopsy case.

    A 34-year-old man developed fever, headache, nausea, double vision, exophthalmus, ptosis, disturbance of vision and oculomotor nerve palsy. magnetic resonance imaging and cerebral angiography led to the clinical diagnoses of cavernous sinus thrombophlebitis and suspicion of bacterial aneurysm of the left internal carotid artery, respectively. peptostreptococcus was detected in blood culture analysis. He died 15 days after admission. Systemic organs showed several septic changes. In particular, the bilateral cavernous sinuses were enlarged and showed severe neutrophilic leukocyte infiltration of the walls and organization, recanalization and abscesses in thrombi. In anterior to the middle cranial fossa, abscess-forming, necrotic, hemorrhagic meningitis, purulent sphenoid sinusitis, pyogenic osteomyelitis of the sphenoid bone, suppurative encephalitis, and inflammatory necrosis of the hypophysis were seen. Based on these findings, we diagnosed the patient with cavernous sinus thrombophlebitis caused by sphenoid sinusitis.
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ranking = 0.33333333333333
keywords = headache
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9/73. Sinonasal disease in patients with sarcoidosis.

    sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.
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ranking = 0.0085947977205788
keywords = upper
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10/73. Nasal mucosal headache presenting as orofacial pain: a review of the literature and a case report.

    Headaches are a significant component of many facial pain syndromes. These facial pain/headache syndromes often have various etiologies, including neurologic, vascular, musculoskeletal, or combinations of vascular/musculoskeletal origins. Referred rhinologic headache, however, can be overlooked as a cause of facial pain in the dental literature. We report a case of nasal mucosal headache that presented as facial pain and include a review of the literature.
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ranking = 2.3333333333333
keywords = headache
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