RESUMO
INTRODUCTION: Isolated sphenoidal sinusitis (ISS) is a rare disease with non-specific symptoms and a potential for complications. Diagnosis is made clinically, endoscopically, and with imaging like CT scans or MRIs. This study aimed to evaluate if ISS meets the EPOS 2020 criteria for diagnosing acute rhinosinusitis and if new diagnostic criteria are needed. MATERIALS AND METHODS: The study analyzed 193 charts and examination records from 2000 to 2022 in patients diagnosed with isolated sphenoidal sinusitis at the Ziv Medical Center in Safed, Israel. Of the 193, 57 patients were excluded, and the remaining 136 patients were included in the final analysis. Patients were evaluated using Ear, Nose and Throat (ENT), neurological and sinonasal video endoscopy, radiological findings, demographic data, symptoms and signs, and laboratory results. All these findings were reviewed according to the EPOS 2020 acute sinusitis diagnosis criteria and were analyzed to determine if ISS symptoms and signs fulfilled them. RESULTS: The patients included 40 men and 96 women, ranging in age from 17 to 86 years (mean ± SD, 37 ± 15.2 years). A positive endoscopy and radiography were encountered in 29.4%, and headache was present in 98%; the most common type was retro-orbital headache (31%). The results showed that there is no relationship between the symptoms of isolated sphenoidal sinusitis and the criteria for diagnosing acute sinusitis according to EPOS 2020. CONCLUSION: ISS is an uncommon entity encountered in clinical practice with non-specific symptoms and a potential for complications. Therefore, the condition must be kept in mind by clinicians, and prompt diagnosis and treatment must be initiated. This kind of sinusitis does not fulfill the standard guidelines for acute sinusitis diagnosis criteria.
Assuntos
Rinite , Sinusite , Sinusite Esfenoidal , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/terapia , Rinite/diagnóstico , Doença Crônica , Sinusite/diagnóstico por imagem , Sinusite/tratamento farmacológico , Cefaleia , Doença AgudaRESUMO
Fungal infections involving the pituitary gland are rare and can be life threatening. A 75-year-old man with hypertension and diabetes mellitus presented with headache and hyponatraemia. Imaging study showed right upper lung mass, and mass resection showed aspergilloma without tissue invasion on histology. The patient developed visual impairment a few weeks later, and MRI of the brain revealed bilateral sphenoid sinusitis and pituitary invasion. The trans-sphenoidal biopsy confirmed invasive Aspergillus infection. His sphenoidal sinuses were endoscopically debrided, and he was treated with oral voriconazole. Pituitary aspergillosis should be considered in the differential diagnosis in patients with lung aspergilloma with headache and sinusitis. Prompt biopsy and antifungal treatment are important due to the high mortality rate of the infection.
Assuntos
Síndrome de Secreção Inadequada de HAD/diagnóstico , Neuroaspergilose/diagnóstico , Doenças da Hipófise/diagnóstico , Aspergilose Pulmonar/diagnóstico por imagem , Idoso , Antifúngicos/uso terapêutico , Complicações do Diabetes , Diabetes Mellitus , Endoscopia , Cefaleia/etiologia , Hemoptise/etiologia , Humanos , Hipertensão , Hiponatremia/etiologia , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Hipopituitarismo/metabolismo , Síndrome de Secreção Inadequada de HAD/etiologia , Síndrome de Secreção Inadequada de HAD/metabolismo , Imageamento por Ressonância Magnética , Masculino , Neuroaspergilose/complicações , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/metabolismo , Doenças da Hipófise/complicações , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/metabolismo , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/cirurgia , Insuficiência Renal Crônica , Sinusite Esfenoidal/complicações , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/terapia , Cirurgia Torácica Vídeoassistida , Voriconazol/uso terapêuticoRESUMO
OBJECTIVE: This study aims to present a case series and systematic review of acute isolated sphenoid sinusitis (AISS) in children in order to better characterize clinical presentation, diagnosis, treatment, and outcomes of this condition. DATA SOURCES: Ovid MEDLINE, Pubmed, Embase, Cochrane Library, and Google Scholar. STUDY SELECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text, peer-reviewed journal publications from 1994 to 2020 in English; focus on acute sphenoid sinusitis; pediatric patients (<18 years of age); series with two or more children. Studies were assessed for data including demographics, presenting symptoms and signs, radiological investigations, treatment, outcomes and complications. RESULTS: Ten studies identifying 71 patients were included. Average age at presentation was 12.0 years (range 5-17 years). M:F ratio 1:1. The most common presenting symptoms were headache (98.6%), fever (50.7%), nasal symptoms (22.5%) ocular symptoms (19.7%) and decreased level of consciousness (12.7%). Twenty patients (28.1%) had neurological signs. Twenty-three patients (32.4%) presented with headache in isolation. Unsuspected diagnosis at presentation was noted in 54.0%. Average time to initial presentation was 14.0 days (median = 5.5 days, range 1-90 days). The majority of children were treated with antibiotics (98.6%) with 31.0%, 2.8% and 2.8% also undergoing sinus surgery, revision sinus surgery and neurosurgery, respectively. Intracranial complications occurred in 16.9% of patients. Significant long term sequelae occurred in 2 children (2.8%) and one death (1.4%) was also reported. LIMITATIONS: All studies were retrospective case note reviews. CONCLUSIONS: Acute sphenoid sinusitis is a rare and difficult condition to diagnose in children. The majority of patients make a full recovery with appropriate treatment. If treatment is delayed however consequences can be life-threatening.
Assuntos
Sinusite Esfenoidal , Doença Aguda , Adolescente , Criança , Pré-Escolar , Cefaleia/etiologia , Humanos , Estudos Retrospectivos , Seio Esfenoidal , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/terapiaRESUMO
BACKGROUND: Pituitary abscesses within pre-existing pituitary conditions, such as craniopharyngioma, pituitary adenoma, or Rathke cleft cyst, are quite rare. A case of pituitary abscess secondary to adenoma is presented, and the literature is reviewed. CASE DESCRIPTION: An 11-year-old boy presented with a 3-day history of sudden-onset headache and visual loss. Magnetic resonance imaging demonstrated a sellar region lesion with intralesional hemorrhage. Preoperative diagnosis was pituitary adenoma with apoplexy. An endoscopic transnasal transsphenoidal approach was used for emergent total tumor resection. Pathology confirmed the diagnosis of pituitary adenoma with apoplexy and inflammation, and microbiologic examination was positive for Staphylococcus aureus. CONCLUSIONS: Secondary pituitary abscess is a rare entity, and preoperative diagnosis is challenging. The treatment strategy includes prompt surgical resection and drainage of the abscess, followed by prolonged antibiotic therapy.
Assuntos
Adenoma/complicações , Abscesso Encefálico/etiologia , Procedimentos Neurocirúrgicos , Apoplexia Hipofisária/complicações , Neoplasias Hipofisárias/complicações , Sinusite Esfenoidal/complicações , Infecções Estafilocócicas/etiologia , Doença Aguda , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Antibacterianos/uso terapêutico , Abscesso Encefálico/patologia , Abscesso Encefálico/terapia , Criança , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/patologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/terapia , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Transtornos da Visão/etiologiaRESUMO
RATIONALE: Cavernous sinus-orbital apex aspergillosis is a rare but serious complication of rhinosinusitis. Pathology results are scarce, and this condition is difficult to diagnose based on clinical and radiological results. PATIENT CONCERNS: A 64-year-old woman presented with cavernous sinus-orbital apex syndrome. Axial and sagittal T1 contrast-enhanced magnetic resonance imaging (MRI) showed a right orbital apex mass abutting the right posterior ethmoid sinus, sphenoid sinus, and cavernous sinus. DIAGNOSIS: Cavernous sinus and orbital apex aspergillosis. INTERVENTIONS: Functional endoscopic sinus surgery was performed, and a biopsy of the lesion tissue was submitted for examination, which showed the presence of aspergillus. OUTCOMES: One year after surgical debridement, antifungal, and anticoagulation treatments, the patient is still asymptomatic without recurrence. LESSONS: Early surgical debridement is crucial to confirm the diagnosis of cavernous sinus-orbital apex aspergillosis and prevent mortality. There is no evidence of negative effects of antibiotic and anticoagulation treatments. Despite controversy, among physicians, most opt to treat patients via anticoagulation therapy.
Assuntos
Aspergilose/microbiologia , Diabetes Mellitus/microbiologia , Doenças Orbitárias/microbiologia , Sinusite Esfenoidal/microbiologia , Anticoagulantes/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/terapia , Seio Cavernoso/microbiologia , Terapia Combinada , Desbridamento/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Órbita/microbiologia , Doenças Orbitárias/terapia , Sinusite Esfenoidal/terapiaRESUMO
In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery.
Assuntos
Lavagem Nasal/métodos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Doenças Nasais/terapia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Assistência ao Convalescente/métodos , Idoso , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/terapia , Criança , Epistaxe/etiologia , Epistaxe/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Perfuração do Septo Nasal/etiologia , Perfuração do Septo Nasal/terapia , Procedimentos Cirúrgicos Nasais/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Nariz/lesões , Nariz/cirurgia , Doenças Nasais/etiologia , Doenças do Nervo Olfatório/etiologia , Doenças do Nervo Olfatório/terapia , Seios Paranasais/fisiopatologia , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Rinite Atrófica/etiologia , Rinite Atrófica/terapia , Seio Esfenoidal/cirurgia , Sinusite Esfenoidal/etiologia , Sinusite Esfenoidal/terapia , Aderências Teciduais/etiologia , Aderências Teciduais/terapia , Adulto JovemRESUMO
Objective:To analyze the clinical characteristics of fungus ball sphenoid sinusitis(FBSS) and its differences from fungus ball maxillary sinusitis(FBMS). Method:A retrospective analysis was made for 50 patients with FBSS and 273 patients with FBMS in the corresponding period, which were confirmed by postoperative pathological diagnosis. And the related factors and clinical characteristics of them were analyzed. Result:FBSS were common disease in women around 50 years old. The left side FBSS was more common than the right side. About 40 percent of patients' disease course was less than half a year.FBSS had many presenting symptoms such as headache, nasal obstruction, nasal mucus with blood, smelly nasal secretions, eye ache bilges or nasion acheand tears spill. However, headache, eye ache bilges and tears spill were more common in FBSS compared with FBMS(P<0.05). The CT scan showed that there were calcification shadows in the diseased softtissue of sinus cavity.It could be accompanied by local bone thickening, sclerosis and coloboma. Only one case had a secondary surgery in 50 cases of FBSS. The surgery cure rate was as high as 98 percent. Conclusion:FBSS had various of clinical symptoms.Some presenting symptoms such as headache, eye ache bilges, and tears spill had relative specificity. CT diagnosis was more specific, and the endoscopic sphenoidotomy was the most effective treatment.
Assuntos
Micoses/diagnóstico , Seio Esfenoidal/microbiologia , Sinusite Esfenoidal/diagnóstico , Endoscopia , Feminino , Fungos , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Estudos Retrospectivos , Sinusite Esfenoidal/microbiologia , Sinusite Esfenoidal/terapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 33-year-old immunocompetent man developed rapid visual loss and a third nerve palsy secondary to acute rhinosinusitis and intracranial abscess formation. Despite endoscopic drainage of the ethmoid and sphenoid sinuses and empiric broad-spectrum antibiotics, the patient experienced progressive visual and neurological decline and ultimately required craniotomy for drainage of an optic apparatus abscess. Although odontogenic sinusitis rarely results in abscess formation of the visual pathways, early recognition and immediate treatment is imperative to decrease the risk of profound and permanent visual impairment.
Assuntos
Cegueira/etiologia , Abscesso Encefálico/complicações , Quiasma Óptico , Sinusite Esfenoidal/complicações , Adulto , Antibacterianos/uso terapêutico , Cegueira/diagnóstico , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/cirurgia , Drenagem/métodos , Endoscopia , Humanos , Imageamento por Ressonância Magnética , Masculino , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/terapia , Tomografia Computadorizada por Raios X , Acuidade VisualRESUMO
The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.
Assuntos
Trombose do Seio Lateral/etiologia , Sinusite Esfenoidal/complicações , Doença Aguda , Adolescente , Humanos , Trombose do Seio Lateral/tratamento farmacológico , Masculino , Meningite Pneumocócica/tratamento farmacológico , Meningite Pneumocócica/etiologia , Sinusite Esfenoidal/terapiaRESUMO
INTRODUCTION: Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications. AIM: Describe four patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of medical or surgical management. Two patients do not required surgical intervention and medical treatment was sufficient. One patient had sphenoidotomy due to meningitis. One patient was performed surgical intervention after fail of medical therapy. Acute isolated sphenoid sinusitis appears to be difficult to diagnose. It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Medical therapy focused on infection, inflammation, and obstruction may be adequate for resolution, but surgical intervention may be required in certain situations.
Assuntos
Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/terapia , Adulto , Feminino , Cefaleia/etiologia , Humanos , Meningite/complicações , Pessoa de Meia-Idade , Seio Esfenoidal/cirurgia , Sinusite Esfenoidal/complicações , Adulto JovemRESUMO
OBJECTIVES: Unlike Aspergillus sinusitis, sinus infections by mucormycosis are often invasive and have a lethal potential. We report two cases of chronic sinusitis with unilateral uncomplicated diagnosis of mucormycosis confirmed by pathology or mycology and discuss the therapeutic strategy. PRESENTATION: Case 1) An immunocompetent patient with a right chronically sphenoid sinusitis uncomplicated underwent endonasal surgery in our institution. Rhizopus Oryzae was found on the surgical mycological specimen. The patient received no adjuvant medical therapy after surgery, because there were no invasive clinical or radiological criteria and no histopathological confirmation. Clinical, radiological and mycological follow-up was done. Case 2) A patient with a chronic maxillary sinusitis underwent endonasal surgery in our institution. Histological analysis found filaments in favor of mucormycosis without vascular emboli. We decided in agreement with the national reference center for mycology not to treat medically. CONCLUSION: A follow up of more than 3 years for both cases tends to confirm this collective decision.
Assuntos
Mucormicose/terapia , Sinusite Esfenoidal/terapia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To improve the diagnosis and treatment of the acute attack of sphenoid and ethmoid fungal ball sinusitis based on the analysis of clinical features. METHOD: Eighteen patients with sphenoid and ethmoid fungal ball sinusitis were reviewed, and the main symptoms included headache and fever during acute attack. Endoscopy, nasal CT and MRI can provide useful information for diagnosis. Endoscopic sinus surgery was performed on thirteen patients after drug therapy, while the other 5 patients chose conservative therapy. RESULT: The pathological examination confirmed the fungal lesions and the 13 patients had a good recovery. The result of CT and MRI scanning had a good accordance with the intra-operative findings. One patient receiving conservative treatment had acute attack again 2.5 months later, and antibiotics and topical nasal drugs improved the symptoms. CONCLUSION: Clinical presentation and radiological imaging contribute to the differential diagnosis of the acute attack of sphenoid and ethmoid fungal ball sinusitis, then the targeted therapy can be taken.
Assuntos
Sinusite Etmoidal/diagnóstico , Micoses/diagnóstico , Sinusite Esfenoidal/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Seio Etmoidal , Sinusite Etmoidal/microbiologia , Sinusite Etmoidal/terapia , Feminino , Fungos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Micoses/terapia , Estudos Retrospectivos , Seio Esfenoidal , Sinusite Esfenoidal/microbiologia , Sinusite Esfenoidal/terapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Infecções Bacterianas/terapia , Desastres , Sinusite Maxilar/terapia , Traumatismo Múltiplo , Afogamento Iminente/complicações , Sinusite Esfenoidal/terapia , Tsunamis , Adulto , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/etiologia , Feminino , Humanos , Japão , Sinusite Maxilar/diagnóstico , Sinusite Maxilar/etiologia , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/etiologiaRESUMO
PURPOSE OF REVIEW: To review the current literature on isolated disease of sphenoid sinus, and to describe the various approaches to the sphenoid sinus. RECENT FINDINGS: Due to its posterior location and subtle presenting symptoms, sphenoid lesions, in the past, have often been missed and were reported as rare occurrences. However, with the availability of current diagnostic modalities such as endoscopy and imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), diseases of the sphenoid sinus are now more frequently diagnosed. Since the introduction of endoscopic techniques in the mid 1980s, various endoscopic approaches to the sphenoid sinus, depending on the extent and type of disease, have been described. These approaches were subsequently 'extended' to remove pituitary tumours, and certain diseases of the parasellar region and the petrous apex. More recently, further extension of these approaches has led to the development of endoscopic skull base surgery, using the sphenoid sinus as the 'gateway' to the anterior, middle and the posterior cranial fossa. These approaches require a clear understanding of the anatomy of the sphenoid sinus and its surrounding regions. SUMMARY: This paper presents a review of the various diseases of the sphenoid sinus and describes the approaches to the sinus with special emphasis on the transpterygoid approach to the lateral recess of the sphenoid sinus.
Assuntos
Doenças dos Seios Paranasais , Seio Esfenoidal , Diagnóstico Diferencial , Humanos , Mucocele/diagnóstico , Mucocele/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/cirurgia , Doenças dos Seios Paranasais/terapia , Neoplasias dos Seios Paranasais/diagnóstico , Neoplasias dos Seios Paranasais/cirurgia , Seio Esfenoidal/cirurgia , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/cirurgia , Sinusite Esfenoidal/terapiaRESUMO
OBJECTIVE: The frequency of invasive fungal sinusitis (IFS) has increased in recent years with the use of steroids, onset of diabetes mellitus, and the administration of antibacterial agents. We report on the clinical features and outcomes of four patients with IFS involving the cavernous sinus and orbit. Prognostic factors facilitating an early diagnosis are described, and the usefulness of combination therapy involving systemic administration of antifungal agents and surgical intervention is discussed. METHODS: We treated four patients with IFS between March 2003 and November 2007 at Ehime University Hospital. Patients were two males and two females, aged from 61 to 74 years (mean 67.8 years). RESULTS: With regard to clinical symptoms, headache was observed in all patients, and cranial nerve paralysis (visual disturbance, blindness, cheek paresthesia) was seen in 3 patients. ß-D-Glucan levels in four patients were high compared with normal values. Aspergillus was histopathologically identified from biopsy specimens in all patients. One patient was complicated with Candida in addition to the Aspergillus infection. Orbital exenteration and ESS were performed in 2 patients as surgical debridement. In all patients, systemic administration of antifungal agents was initiated after surgery. CONCLUSIONS: All patients received strategic treatment with surgery and systemic administration of anti-fungal agents. The single fatality was due to brain infarction caused by the spread of Aspergillus, and the remaining three patients are still alive. Our observations in these patients suggest that early diagnosis and strategic treatment may improve the prognosis of IFS.
Assuntos
Aspergilose/diagnóstico , Candidíase/diagnóstico , Seio Cavernoso , Sinusite Maxilar/diagnóstico , Doenças Orbitárias/diagnóstico , Sinusite Esfenoidal/diagnóstico , Idoso , Antifúngicos/administração & dosagem , Aspergilose/patologia , Aspergilose/terapia , Biópsia , Cegueira/etiologia , Infarto Encefálico/etiologia , Candidíase/patologia , Candidíase/terapia , Seio Cavernoso/patologia , Terapia Combinada , Desbridamento , Diagnóstico Precoce , Equinocandinas/administração & dosagem , Evolução Fatal , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Lipopeptídeos/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Sinusite Maxilar/patologia , Sinusite Maxilar/terapia , Micafungina , Pessoa de Meia-Idade , Exenteração Orbitária , Doenças Orbitárias/patologia , Doenças Orbitárias/terapia , Complicações Pós-Operatórias/etiologia , Pirimidinas/administração & dosagem , Sinusite Esfenoidal/patologia , Sinusite Esfenoidal/terapia , Tomografia Computadorizada por Raios X , Triazóis/administração & dosagem , VoriconazolRESUMO
The author describes 7 clinical cases of epilepsy with the presence of sinusitis and one case with chronic otitis. Sphenoiditis was noted in all cases. In tree cases, epileptic seizures disappeared after the sanation of sinuses and after the radical surgery intervention in one patient as well. To exclude respiratory origin of epilepsy, CT and MRT of paranasal sinuses in all cases of epilepsy are recommended.
Assuntos
Epilepsia/etiologia , Epilepsia/terapia , Doenças Raras/etiologia , Doenças Raras/terapia , Sinusite/complicações , Adulto , Idoso de 80 Anos ou mais , Criança , Epilepsia/diagnóstico , Feminino , Sinusite Frontal/complicações , Sinusite Frontal/diagnóstico , Sinusite Frontal/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Sinusite Maxilar/complicações , Sinusite Maxilar/diagnóstico , Sinusite Maxilar/terapia , Pessoa de Meia-Idade , Otite/complicações , Otite/diagnóstico , Otite/terapia , Doenças Raras/diagnóstico , Sinusite/diagnóstico , Sinusite/terapia , Sinusite Esfenoidal/complicações , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/terapia , Tomografia Computadorizada por Raios XRESUMO
A 40-year-old male with left-sided headaches, ptosis, proptosis and extra-ocular muscle paralysis developed right-sided headaches, proptosis, chemosis, diplopia, extra-ocular muscle paralysis and trigeminal sensory loss. An enhancing left orbital, intrasellar and parasellar cavernous nodule on magnetic resonance imaging progressed into a right cavernous sinus and orbital apex soft tissue mass. Cavernous sinus syndrome from sphenoid sinusitis resolved after endoscopic transnasal sphenoidotomy. This diagnostic complexity and its treatment options are discussed according to current literature.
Assuntos
Trombose do Corpo Cavernoso/patologia , Sinusite Esfenoidal/complicações , Adulto , Trombose do Corpo Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/etiologia , Trombose do Corpo Cavernoso/terapia , Drenagem , Exoftalmia/etiologia , Humanos , Masculino , Radiografia , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/patologia , Sinusite Esfenoidal/terapia , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/fisiopatologiaRESUMO
OBJECTIVE: To report what we believe to be the first case in the English language literature of unilateral cavernous sinus thrombosis complicating contralateral sphenoid sinusitis. CASE REPORT: A 62-year-old man presented to his general practitioner with a severe, right-sided, temporal headache. He was diagnosed with temporal arteritis and treated with systemic steroids. After five days, he developed right proptosis, ophthalmoplegia and ptosis. He was referred to the neurologists. After an urgent computed tomography head scan and computed tomography angiogram, a diagnosis of carotido-cavernous fistula was made. However, this was subsequently excluded after a negative cerebral angiogram. A review of the scans enabled diagnosis of right cavernous sinus thrombosis secondary to left sphenoiditis. The patient was referred to the otolaryngology team. After an urgent endoscopic sphenoidotomy and medical treatment, all symptoms and signs improved dramatically. CONCLUSIONS: Sphenoiditis can lead to contralateral cavernous sinus thrombosis. Urgent surgical sphenoidotomy, with appropriate medical treatment, can be successful in this life-threatening complication.