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Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature. Ophthalmic Plast Reconstr Surg 2019; 35:272-280. [DOI: 10.1097/iop.0000000000001231] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dolapsakis C, Kranidioti E, Katsila S, Samarkos M. Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis. BMJ Case Rep 2019; 12:12/1/e227302. [PMID: 30700458 DOI: 10.1136/bcr-2018-227302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of septic thrombosis of the right cavernous sinus in a diabetic woman in her late 70's due to ipsilateral sphenoid sinusitis. The diagnosis was delayed and made only after the abrupt and dramatic appearance of the manifestations of sinus thrombosis. The patient developed, among the other symptoms, right peripheral facial palsy, which is a very rare manifestation in cavernous sinus thrombosis (CST). She was treated with broad-spectrum antibiotics and enoxaparin. The day of the scheduled drainage of sphenoid sinus-24 hours after the initiation of anticoagulation-she developed fatal subarachnoid haemorrhage. Our case demonstrates the difficulty of timely diagnosis of acute sphenoid sinusitis which has emerged as the most common primary infectious source potentially leading in CST. It also underscores the uncertainty concerning the use of anticoagulation in cerebral sinus thrombosis of infectious origin.
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Affiliation(s)
| | | | - Sofia Katsila
- 3rd Department of Medicine, Evaggelismos General Hospital, Athens, Greece
| | - Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, Athens, Greece.,National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
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Fabre C, Atallah I, Wroblewski I, Righini CA. Maxillary sinusitis complicated by stroke. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:449-451. [PMID: 30072286 DOI: 10.1016/j.anorl.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Neurological complications of acute sinusitis are exceptional, but potentially serious. CASE REPORT The authors report the case of a 6-year-old diabetic girl who presented with middle cerebral artery ischemic stroke secondary to inflammatory arteritis of the left internal carotid artery in a context of bilateral acute maxillary sinusitis. MRI confirmed ischaemic stroke associated with carotid arteritis and complete obstruction of the maxillary sinuses. A favourable outcome was observed after endoscopic drainage of the sinuses associated with broad-spectrum antibiotic therapy. DISCUSSION This complication was probably due to spread of an infectious inflammatory reaction of the intrapetrosal carotid artery and its branches via the pterygoid venous plexus. To our knowledge, this is the first published case report of maxillary sinusitis complicated by stroke.
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Affiliation(s)
- C Fabre
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France.
| | - I Atallah
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France; Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France
| | - I Wroblewski
- Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France; Réanimation et surveillance continue pédiatrique, pôle Couple Enfant, CHU de Grenoble, Grenoble, France
| | - C A Righini
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France; Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France
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Lal D, Jategaonkar AA, Borish L, Chambliss LR, Gnagi SH, Hwang PH, Rank MA, Stankiewicz JA, Lund VJ. Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations. Rhinology 2016. [PMID: 26800862 DOI: 10.4193/rhin15.228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Management of rhinosinusitis during pregnancy requires special considerations. OBJECTIVES 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. METHODS The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. RESULTS Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. CONCLUSIONS The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
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Affiliation(s)
- Devyani Lal
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | | | - Larry Borish
- Departments of Medicine and Microbiology, University of Virginia, Charlottesville, VA, USA
| | - Linda R Chambliss
- Division of Maternal Fetal Medicine, St. Josephs Hospital and Medical Center, Phoenix, AZ, USA
| | - Sharon H Gnagi
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | - Peter H Hwang
- Department of Otolaryngology, Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | - James A Stankiewicz
- Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom
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Lal D, Jategaonkar AA, Borish L, Chambliss LR, Gnagi SH, Hwang PH, Rank MA, Stankiewicz JA, Lund VJ. Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations. Rhinology 2016; 54:99-104. [PMID: 26800862 DOI: 10.4193/rhino15.228] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Management of rhinosinusitis during pregnancy requires special considerations. OBJECTIVES 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. METHODS The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. RESULTS Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. CONCLUSIONS The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
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Affiliation(s)
- Devyani Lal
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | | | - Larry Borish
- Departments of Medicine and Microbiology, University of Virginia, Charlottesville, VA, USA
| | - Linda R Chambliss
- Division of Maternal Fetal Medicine, St. Josephs Hospital and Medical Center, Phoenix, AZ, USA
| | - Sharon H Gnagi
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | - Peter H Hwang
- Department of Otolaryngology, Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | - James A Stankiewicz
- Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom
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Tsai PT, Chen YW. Septic cavernous sinus thrombosis and blindness following odontogenic infection. J Dent Sci 2016; 11:210-211. [PMID: 30894974 PMCID: PMC6395241 DOI: 10.1016/j.jds.2015.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/14/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pai-Tai Tsai
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Tri-Service General Hospital DDS, Taipei Medical University, Taipei City, Taiwan, ROC.,Dental School, National Defense Medical Center, Taiwan, ROC
| | - Yuan-Wu Chen
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Tri-Service General Hospital DDS, Taipei Medical University, Taipei City, Taiwan, ROC.,Dental School, National Defense Medical Center, Taiwan, ROC
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Patel AP, Masterson L, Deutsch CJ, Scoffings DJ, Fish BM. Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol 2015; 79:868-873. [PMID: 25887135 DOI: 10.1016/j.ijporl.2015.03.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. METHODS All children with sinogenic intracranial abscesses presenting to a large university teaching hospital over a five-year period were included in the study. Data on clinical presentation, radiological findings, microbiology, medical and surgical management and follow-up were recorded and analysed. RESULTS We identified 27 children aged 12.9 ± 3.4 years of which 56% were male. Fourteen (52%) children had extradural abscesses, nine (33%) subdural abscesses and four (15%) parenchymal abscesses. Early sinus drainage procedures were performed on 24 (89%) patients, and the same number required neurosurgical drainage. Streptococcus milleri was isolated in 18 (67%) cases. An initial conservative neurosurgical approach failed in 50% of cases where trialled, and was associated with longer length of stay (p = 0.025). In comparison to extradural abscesses, subdural abscesses were more likely to present with neurological deficits (p < 0.001) and reduced consciousness (p = 0.018), and required multiple neurosurgical procedures (p < 0.001), longer stays (p = 0.017), and had greater morbidity at six months (p = 0.017). A third of children had significant morbidity at six months, which included cognitive and behavioural problems (25%), residual hemiparesis (19%) and expressive dysphasia (7%). There were no mortalities. CONCLUSION Sinusitis complicated by intracranial abscess remains a contemporary problem. We demonstrate good outcomes with an early combined rhinological and neurosurgical approach. S. milleri is identified as the causative organism in the majority of cases, and empirical antimicrobial treatments should reflect this.
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Affiliation(s)
- Anant P Patel
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Liam Masterson
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christopher J Deutsch
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daniel J Scoffings
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian M Fish
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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