Intracranial complications of pediatric frontal rhinosinusitis.
BACKGROUND
The aim of this study was to review the presentation and management of children admitted for intracranial complications arising from frontal rhinosinusitis. We performed a retrospective case series review at two academic tertiary care children's hospitals.


METHODS
This study consisted of children < 18 years old who presented with intracranial complications from frontal rhinosinusitis between January 1, 1990 and December 31, 2002. Relevant literature was reviewed with the assistance of Medline. Presentation, type of intracranial complication, radiographic evaluations, response to treatment, and prognosis were evaluated.


RESULTS
Sixteen patients were identified with intracranial complications due to frontal rhinosinusitis. Patients were usually older (mean age, 14 years and 3 months), of male gender (M/F, 4.3:1.0), and African American (AA/W, 3.0:1.0). Headache, nasal congestion, and visual changes were the most common early symptoms and neurological findings indicated advanced disease. Subdural (56%), epidural (44%), and cerebral abscesses (19%) were the most common complications. Meningitis alone was identified in 13% and was associated with another intracranial complication in 6%. Multiple intracranial complications were noted in 31%. Polymicrobial cultures were obtained in 50% of patients. Although CT was excellent in identifying orbital pathology, MRI was superior for characterization of intracranial disease.


CONCLUSIONS
Intracranial complications of frontal rhinosinusitis are rare in children. Early symptoms often are nonspecific, with neurological findings more commonly seen in advanced disease. Adolescent African American male patients were found to be at highest risk for intracranial complications from frontal rhinosinusitis. Headache and orbital complaints associated with rhinosinusitis in older children failing to respond to initial therapy should prompt an aggressive evaluation including MRI.
Herrmann
Brian W
BW
Department of Otolaryngology-Head and Neck Surgery, Washington University, School of Medicine, St. Louis, Missouri, USA. bherrmann@childrensent.com
Chung
James C
JC
Eisenbeis
John F
JF
Forsen
James W
JW
D000293:Adolescent; D002494:Central Nervous System Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D020802:Epidural Abscess / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D015522:Frontal Sinusitis / Q000382:microbiology / Q000601:surgery*; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000382:microbiology / Q000601:surgery*