Central nervous system complications secondary to rhinosinusitis: a case report

Case presentation: A previously healthy 12 year-old male presented to our tertiary emergency care with classic meningoencephalitis symptoms and paraparesis, urinary retention, facial nerve palsy, lagophtalmos, abducens nerve palsy, oculomotor nerve palsy and hypoesthesia secondary to sinusitis complications. These were intracranial lesions, multiple ischemic subcortical areas and myelitis. The diagnosis was made through clinical examination, imaging tests and laboratory tests of blood and cerebrospinal fluid, including serology and cultures. Treatment was intravenous antibiotic, steroids, anticoagulants, nasoendoscopic surgery and rehabilitation therapies.

Discussion: Central Nervous System involvement in complicated acute rhinosinusitis is rare. That includes meningitis, sinus thrombosis and cerebral abscesses. Despite the improvement in the treatment of sinusitis due to the greater availability of antibiotics and the consequent lower incidence of complications, the mortality of these cases can reach 10–20% and patients may have long term neurologic sequels. The database about ischemic strokes secondary to acute sinusitis in the childhood are rare. The CNS complications of sinusitis are due to the sinus inflammation and pathophysiological mechanisms which can cause dehiscence and erosion of sinus wall and by progression of septic thrombi or transmission of septic emboli through the valveless diploic veins of the skull base that penetrates dura. In the patient case, there were clinical and imaging changes consistent with intracranial (meningitis with areas of infarction and superior sagital sinus thrombosis) and medullary (meningoradiculitis with foci of cervicothoracic myelitis) involvement, suspicious findings for an infectious and inflammatory process.

Final comments: Mortality by intracranial complications of sinusitis have been decreasing, but they still carry a high risk of long-term morbidity like epilepsy, permanent visual changes, and focal paresis. And our best chance to improve the outcome is through early diagnosis and treatment with a multidisciplinary approach.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023