Intracranial complications of

sinusitis
• Incidence unknown
• More common in 2nd-3rd decade
• 3-4:1 male: female
• Direct extension or venous spread
• 10% of all intracranial suppuration related to
sinus disease
• Frontal sinus most common site involved
• SE is the most common sinusitis associated
intrancranial infection
 Signs/symptoms
• Orbital complications and intracranial infection
coexist in up to 45% of cases
• Fever
• Headache
• Altered mental status,
• Hemiparesis
• Nausea/Vomitn
• Seizures
• Meningsmus
• Periobtal edema
Meningitis Sphenoid, ethmoid Acute, rapid progression
Meningismus

Subdural empyema Frontal Rapidly progessing –

meningeal + increased
pressure – focal neuro
deficits

Cavernous sinus All Subacute, periorbital

thrombosis swelling, diplopia,
proptosis

Epidural abscess Frontal Slow growing, indolent,

eventually signs of
increased ICP

Intracranial abscess Frontal, Ethmoid Indolent, fever,

headache, focal neuro
deficits
 Bacterial coverage
• Usually polymicrobial – gram + cocci, strep
(viridans, milleri), anaerobic gram negative bacilli
• After trauma – Staph aureus, Gram + cocci
• After meningitis – Gram negative bacilli,
causative agent of meningitis
• Otorhinolaryngeal related – anaerobes,
polymicrobial
• Infants – more commonly related to trauma
(subdural bleeds) or meningitis with fluid
collection thereafter
 Treatment
• Prolonged IV abx – 4-6 weeks
• Follow up imaging
• Immediate evacuation