SINOGENIC INTRACRANIAL COMPLICATIONS

Two hundred and nineteen patients, with intracranial complications of sinusitis, are presented. Sinusitis is still a life-threatening condit ion and if neglected, or mismanaged, can lead to intracranial complica tions that result in a high mortality and morbidity. Twenty-two patien ts had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema. The dia gnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, c hemistry and culture. The most frequent presenting signs were fever (6 8 per cent) and headache (54 per cent). The most common localizing neu rological sign was hemiparesis (35.5 per cent). Orbital inflammation w as present in 41.5 per cent of patients. Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, perfo rmed within 12 hours of admission. In patients with meningitis, the su rgery entailed surgery of the sinus disease only. In patients with sub dural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approa ch, immediately after drainage of the intracranial collection of pus, was carried out. There were 35 deaths (16 per cent). The highest morta lity rate was recorded in patients with meningitis (45 per cent) follo wed by brain abscess (19 per cent) and subdural empyema (11 per cent). Despite advances in medicine, i.e. antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial comp lications has remained significant. This can only be eliminated throug h education. This paper emphasizes to younger generations of otolaryng ologists and primary care physicians that sinusitis is a serious disea se and there is no place for delay or complacency when managing such p atients.