Adriana Hristea 1,2, Mihaela Ion 2, M. Lazăr 1,2, Ruxandra Moroti 1,2, Roxana Petre 2, Victoria Aramă 1,2, Cristina Popescu 1,2, Smaranda Gliga 1,2
1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 “Prof. Dr. Matei Balş” National Institute for Infectious Diseases, Bucharest, Romania
Abstract
Central nervous system (CNS) infections present significant mortality and morbidity, being life threatening diseases which can easily develop into challenges for physicians, despite the advances of modern medicine, in respect to development of antibiotics and modern surgical techniques [16]. Since the advent of magnetic resonance imaging (MRI), the mortality has dropped significantly. We present the cases of two patients with intracranial complications of mastoiditis and respectively an infection of the paranasal sinuses. A patient of 33 years-old has been addressed with suspected meningitis after surgery for chronic suppurative otomastoiditis. The MRI showed the presence of an abscess of 2.5 cm in the right temporal lobe with perilesional edema and thrombosis in the right transverse sinus, accompanied by oto-mastoids inflammatory infectious changes which required surgical drainage and then parenteral antibiotic therapy for one month. Our second case was a 15 year-old patient without an eloquent medical history who was addressed by a neurosurgery service, with the diagnosis of acute encephalitis secondary to an acute pansinusitis. After admissions into our service his clinical and neurological status rapidly deteriorated and an emergency brain MRI showed an extended subdural collection on the right side of the brain (frontal, parietal and temporal lobe) and interhemispheric collection carrying out a mass effect on the ventricular system and intrasinusal collections in the maxillary, right frontal and anterior ethmoidal sinuses. He was transferred into a neurosurgical service where surgery was performed in association with pre and postsurgical antibiotic therapy. The patient had a slow but favorable recovery. We emphasize the need of an early and appropriate diagnosis using imaging techniques in order to improve the management of intracranial complications of ear and sinus infections.