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Titolo:
Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: Case report
Autore:
Sahjpaul, RL; Lee, DH;
Indirizzi:
Univdaestern Ontario, Dept Clin Neurol Sci, Div Neurosurg, London, ON, Cana Univ Western Ontario London ON Canada i, Div Neurosurg, London, ON, Cana Univnadatern Ontario, Dept Clin Neurol Sci, Div Neuroradiol, London, ON, Ca Univ Western Ontario London ON Canada i, Div Neuroradiol, London, ON, Ca
Titolo Testata:
NEUROSURGERY
fascicolo: 4, volume: 44, anno: 1999,
pagine: 864 - 867
SICI:
0148-396X(199904)44:4<864:ISEPAA>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Keywords:
cavernous sinus thrombophlebitis; infratentorial empyema; paranasal sinusitis; pituitary abscess;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
18
Recensione:
Indirizzi per estratti:
Indirizzo: Sahjpaul, RL 339 Windermere Rd, London, ON N6A 5A5, Canada 339 WindermereRd London ON Canada N6A 5A5 N N6A 5A5, Canada
Citazione:
R.L. Sahjpaul e D.H. Lee, "Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: Case report", NEUROSURGER, 44(4), 1999, pp. 864-867

Abstract

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. CLINICALPRESENTATION: A 26-year-oId 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 andinfection 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 andcoagulase-negative staphylococcus species. The patient survived but duringthe 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/11/20 alle ore 16:23:01