1/19. Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report.OBJECTIVE AND IMPORTANCE: Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man. CLINICAL PRESENTATION: A 26-year-old man with a remote history of sinusitis developed rapidly progressive headache, fever, right eye pain, swelling, proptosis, and visual impairment. magnetic resonance imaging demonstrated diffuse pansinusitis, including sphenoid sinusitis, and extension of inflammation and infection into the adjacent cavernous sinuses, pituitary gland, and posterior fossa. INTERVENTION: Urgent drainage of the ethmoid and maxillary sinuses was performed; pus was not identified. The patient continued to deteriorate clinically with worsening of visual acuity. Computed tomography of the head performed the next day revealed worsening hydrocephalus and an enlarging posterior fossa subdural empyema. Urgent ventricular drainage and evacuation of the empyema was performed, and subsequently, the patient's clinical course improved. The microbiology results revealed alpha hemolytic streptococcus and coagulase-negative staphylococcus species. The patient survived but during the follow-up period had a blind right eye and pituitary insufficiency. CONCLUSION: Paranasal sinusitis can have devastating intracranial sequelae. Involvement of the adjacent pituitary gland and cavernous sinuses can result in serious neurological morbidity or mortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvement. A high index of suspicion and aggressive medical and surgical treatment are crucial for patient survival, but the morbidity rate remains high. Our patient survived but lost anterior pituitary function and vision in his right eye.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
2/19. Is sphenoid sinus opacity significant in patients with optic neuritis?PURPOSE: optic neuritis secondary to sinus disease is an infrequent but well-documented association. When a patient presents with signs of optic nerve dysfunction and orbital inflammation the significance of widespread sinus disease on radiology is clear and the management is straightforward. We present a group of patients with isolated optic neuritis and radiological evidence of spheno-ethmoiditis and discuss the clinical relevance of this finding. methods: We reviewed the notes of 11 patients with optic neuritis who, because of atypical headache, underwent neuroimaging revealing sphenoid sinus opacity. Six patients had endoscopic drainage of the sphenoid sinus; 4 were treated medically. RESULTS: Sinus contents included fungal infection (2), mucopurulent material (5), polyps (1) and necrotic tumour (1). Narrowing of the optic canal due to chronic osteomyelitis was found in 1 patient with irreversible optic atrophy. Visual loss was reversible in 6 patients. Four patients had normal radiological findings after treatment. Two patients had recurrent optic neuritis with sphenoid sinusitis on MRI scan, resolving on treatment, during the 4 year follow-up period. CONCLUSIONS: Possible mechanisms of nerve damage in this situation include direct spread of infection, occlusive vasculitis and bony deficiency in the wall of the sinus. patients presenting with isolated optic neuritis and atypical headache should be scanned; an opaque sphenoid sinus in the context of visual loss should not be dismissed as coincidental but assumed to be pathological and the patient referred for drainage. sphenoid sinusitis is an uncommon but treatable cause of optic neuritis.- - - - - - - - - - ranking = 2keywords = headache (Clic here for more details about this article) |
3/19. Superior branch palsy of the oculomotor nerve caused by acute sphenoid sinusitis.A 52-year-old man presented with unilateral headache for 6 days. physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with chemosis. CT scan of the paranasal sinuses showed ipsilateral sphenoid sinusitis with cavernous sinus involvement. The symptoms were completely improved by medical treatment only.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
4/19. Pituitary abscess secondary to isolated sphenoid sinusitis.Intracranial complications from isolated sphenoid sinusitis are rare but nevertheless demonstrate both a high morbidity and mortality. We herein report a case of a pituitary abscess secondary to sphenoid sinusitis in a 12-year-old boy. This patient presented with an acute onset of moderate fever and headache, followed by progressive right ptosis. An emergency endoscopic endonasal sphenoidotomy with sinus drainage and postoperative antibiotic therapy resulted in a satisfactory recovery.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
5/19. sphenoid sinusitis caused by clostridium perfringens.Anaerobic bacterial infections in chronic sinusitis are well described in literature. We present what is believed to be the first reported case of clostridium perfringens presenting as the causative pathogen in paranasal sinusitis. This patient presented with severe headaches and, with CT and MRI findings of unilateral sphenoid sinus opacification, with bone demineralization and intrasinus calcification. This patient responded to endoscopic debridement and long-term antibiotics without sequelae.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
6/19. sphenoid sinusitis masquerading as migraine headaches in children.The sphenoid sinus is often referred to as the "neglected sinus." Isolated sphenoid sinusitis is a rare disease with potentially devastating complications. It occurs at an incidence of about 2.7% of all sinus infections. Although headache is the most common presenting symptom, there is no typical headache pattern. Three cases of children with isolated sphenoid sinusitis presenting with acute, subacute, and chronic headache symptoms are presented. The sensory innervation of the sphenoid sinus is derived from the ophthalmic and maxillary branches of the trigeminal nerve, which may explain the pathophysiology of the headache, similar to the trigeminovascular pain theory of migraine. There are few reports on sphenoid sinusitis and headache; however, modern neuroimaging has made this probably under-recognized disorder easier to diagnose and treat. Although the diagnosis can be difficult to differentiate from migraine headache, early and appropriate treatment usually results in an excellent outcome without morbidity.- - - - - - - - - - ranking = 10keywords = headache (Clic here for more details about this article) |
7/19. Aspergillus sphenoid sinusitis-induced orbital apex syndrome in hiv infection.BACKGROUND: Orbital apex syndrome due to aspergillus sphenoid sinusitis is a rare condition. Human immunodeficiency virus (hiv) infection has recently been reported in aspergillus orbital abscess. To the authors' knowledge this is the first reported association of hiv with the orbital apex syndrome. methods: A 37-year-old hiv-infected man presented with headache, reduced vision and progressive ophthalmoplegia in the right eye. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed sphenoid sinusitis. Sphenoid sinus biopsy was performed. RESULTS: light microscopy revealed infiltrative branching septate fungal hyphae. Fungal culture isolated aspergillus fumigatus. CONCLUSION: Atypical fungal infection such as aspergillus fumigatus sphenoid sinusitis should be suspected in hiv-infected patients with orbital apex syndrome.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
8/19. Infectious and neoplastic diseases of the sphenoid sinus--a report of 10 cases.Sphenoid opacifications may be discovered during the radiological work up of patients presenting with fever, headache, or neurological changes. While most of these patients do not require surgical intervention, prompt assessment and management is nevertheless required. Ten patients who underwent sphenoidotomy for drainage or biopsy at Montefiore Hospital during a 4-year period from September 1995 through January 2000 are presented. Nine out of 10 patients had predisposing factors such as AIDS, diabetes, leukemia, and end-stage renal disease. The most common presentation was altered mental status. One patient rapidly developed cavernous sinus thrombosis. microbiology of sphenoid cultures included various fungi, mycobacterium avium intracellulare, coagulase negative Staphylococci, and corynebacterium. neoplastic processes included non-Hodgkin's lymphoma and sinonasal undifferentiated carcinoma. When evaluating hospitalized patients with sphenoid sinus disease, a thorough history and a bedside nasal endoscopy should be performed. Conservative management in the form of intravenous antibiotics and topical decongestion should always be the first line of treatment. Those patients with clinical or radiological evidence of disease extending beyond the confines of the sphenoid sinus require immediate surgical intervention.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
9/19. Powered endoscopic marsupialization for recurrent sphenoid sinus mucocele: a case report.We report a case of recurrent sphenoid mucocele successfully treated by using a powered instrument under endoscopic control. A 59-year-old male came to our clinic complaining of severe headache, right-side facial numbness (in the areas of the first and second branches of the trigeminal nerve), diplopia, and right blepharoptosis. Computed tomography (CT) imaging revealed opacification and expansion of the sphenoid sinus lesion. The lesion was diagnosed as right-side sphenoid mucocele affecting the functions of the trigeminal (first and second branches), oculomotor, and abducent nerves. Endoscopic drainage of the right-side sphenoid mucocele leads to gradual improvement of these symptoms. Approximately 1 year after the drainage procedure, the size of the enlarged sphenoid sinus ostium had decreased. The patient underwent endoscopic right-side total marsupialization of the sphenoid sinus using a powered instrument. Subsequently, the patient has presented no evidence of recurrent disease after 1 year of follow-up.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
10/19. Acute isolated sphenoid sinusitis.INTRODUCTION: Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis. It is frequently misdiagnosed because of its vague symptoms and the paucity of clinical findings. We report 2 cases of isolated acute isolated sphenoid sinusitis with unusual presentations. CLINICAL PICTURE: Both patients presented with acute headache, eye pain and fever, and were provisionally diagnosed as meningitis. In 1 case, the symptoms were on the contralateral side of the sphenoid infection. Intracranial complications were also present. TREATMENT: Treatment included intravenous antibiotics and endoscopic sphenoidotomy. OUTCOME: Both patients recovered with no residual neurological disability. CONCLUSION: Acute sphenoiditis usually presents with subtle symptoms and elusive physical findings and hence a high index of suspicion is necessary. Complications may arise due to the close proximity of important structures to the sphenoid sinus. Uncomplicated cases can resolve with optimal antibiotic therapy if diagnosed and treated early. Persistence or progression of disease with development of intracranial complications are indications for immediate surgical drainage.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
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