Dados do Trabalho

Título

CENTRAL NERVOUS SYSTEM COMPLICATIONS OF PEDIATRIC SINUSITIS

Introdução

Central nervous system (CNS) involvement in pediatric acute sinusitis is rare. Intracranial complications involve meningitis, sinus thrombosis, empyemas and cerebral abscesses. We present a series of ten cases evaluated in a period of eight months in our tertiary pediatric referral center.

Objetivo

To gain insight into patterns of presentation, epidemiology, imaging, disease course of intracranial complications of sinusitis (ICS), challenging conditions with high morbidity and potential mortality.

Métodos

Clinical observation of ten children and adolescents treated for sinusitis intracranial complications in a period of eight months between 2021-2022.

Resultados

Ten patients were identified with an average age of 9.8 years old, with a minimum of two and a maximum of 13 years old. 60% were adolescents, 30% where grade-schoolers and, surprisingly, 10% was toddlers. 80% were male. As for the localization, the frontal sinus was affected in all patients and 60% had pansinusitis. The most common symptoms were fever, present in 90%, and headache, present in 70%. Neurological abnormalities such as paraparesis and hemiplegia were present in 30%, all male with 12 and 13 years old. Focal seizures occurred in 30%. Meningitis was the most common complication, present in 80%, followed by intracranial empyemas in 70%. Intracranial abscesses occurred in 30% and 30% evolved with sinus thrombosis, where 20% had superior sagittal sinus thrombosis. One 12-year-old male had extended CNS complications as paraparesis, urinary retention, facial nerve palsy, lagophtalmos, abducens nerve palsy, oculomotor nerve palsy and hypoesthesia secundary to intracranial lesions, multiple ischemic subcortical areas and mielitis. One 11-year-old male had intracranial hypertension due to a massive frontal abscess. Treatment outcomes showed that only 30% of patients were exclusively treated with antibiotics and 70% needed surgical interventions. 30% had nasoendoscopic surgery, 30% had neurosurgical intervention and 10%, a ten-year-old female, had both surgeries.

Conclusões

For the first time, our hospital had so many sinusitis complicated cases in a brief period of time. Fortunately, we had no mortality rate. These complications should be rare, so the question about the reason behind so many serious cases is raised. Also important, sinusitis in a 2 years old is unusual and unexpected, so we highlight the need of early diagnosis and treatment to further prevent complications.

Palavras chave

Children; Sinusitis; Meningitis; Abscess; Empyema

Referências (se houver)

1. Otto WR, Paden WZ, Connors M, Joerger T, Buzi A, Rizzi M, Huh J, Storm P, Heuer G, Kennedy B, McGuire J, Swami S, Lang SS. Suppurative Intracranial Complications of Pediatric Sinusitis: A Single-Center Experience. J Pediatric Infect Dis Soc. 2021 Apr 3;10(3):309-316. doi: 10.1093/jpids/piaa101. PMID: 32955086; PMCID: PMC8023312.

2. Clement WA, Sooby P, Doherty C, Qayyum N, Irwin G. Acute isolated sphenoid sinusitis in children: A case series and systematic review of the literature. Int J Pediatr Otorhinolaryngol. 2021 Jan;140:110492. doi: 10.1016/j.ijporl.2020.110492. Epub 2020 Nov 11. PMID: 33234332.

3. Lundy P, Kaufman C, Garcia D, Partington MD, Grabb PA. Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr. 2019 Mar 22;24(1):14-21. doi: 10.3171/2019.1.PEDS18434. PMID: 31553545.

4. Din-Lovinescu C, Mir G, Blanco C, Zhao K, Mazzoni T, Fried A, El Khashab M, Lin G. Intracranial complications of pediatric rhinosinusitis: Identifying risk factors and interventions affecting length of hospitalization. Int J Pediatr Otorhinolaryngol. 2020 Apr;131:109841. doi: 10.1016/j.ijporl.2019.109841. Epub 2019 Dec 19. PMID: 31901485.

Fonte de Fomento (se houver)

Declaração de conflito de interesses de TODOS os autores

Declaramos que não há conflitos de interesse.

Área

Neuroinfecções