Assuntos
Empiema Subdural , Comunicação Interventricular , Humanos , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/etiologia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/complicações , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Spontaneous central nervous system (CNS) infections in children are rare. Treatment involves surgical intervention and antibiotic therapy. We describe a single centre experience of managing this condition in South Wales. METHODS: We performed a retrospective review of surgically managed cases in our unit for patients under 18 years of age between 2008 and 2018. Data were collected regarding aetiology, location, microbiology examination, treatment and outcomes. RESULTS: Twenty-six patients were identified of which 25 case notes were available. Fifteen were male and 10 were female. Median age was 12 years (age range 0.3-17 years). Seven patients (28%) had a burr-hole aspiration and 18 (72%) underwent craniotomy. A second procedure was performed in 10 (40%) and a third procedure in two (8%). Fourteen (56%) had a brain abscess, 10 (40%) had subdural empyema (one was bilateral) and one (4%) had an extradural empyema. Fifteen (60%) had a raised WCC (>11.5 × 109/L) and 22 (88%) had a CRP of >10 mg/L at presentation. Three (12%) patients had a normal WCC and CRP at presentation. Overall, 12 (48%) were secondary to sinus infection, with the most common organism being Streptococcus. Seven (28%) were due to otitis media or mastoiditis, six (24%) had no cause identified. The mean number of CT/MRI scans was 6.7 (range 3-13). The mean follow-up period was 16.7 months (range 1-117 months). At last follow up, 19 (76%) had a GOS of 5, five (20%) had a GOS of 4 and one (12%) had GOS of 3. There were no deaths. CONCLUSIONS: In Wales, outcomes have improved over time in keeping with other paediatric neurosurgical units in England. Increased availability of imaging resources in our hospital and use of neuro-navigation for all cases in our unit as well as earlier identification of sepsis, communication with microbiologists with dedicated ward rounds and, enhanced identification of causative organisms and contemporary anti-microbials have also contributed towards the improved management of this condition.
Assuntos
Abscesso Encefálico , Empiema Subdural , Criança , Humanos , Masculino , Feminino , Adolescente , Lactente , Pré-Escolar , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/cirurgia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Abscesso Encefálico/etiologia , Craniotomia/métodos , Supuração/complicações , Supuração/cirurgia , Trepanação/efeitos adversos , Estudos RetrospectivosRESUMO
Lawsonella clevelandensis is a recently described species and genus of bacterium in the Corynebacterineae suborder which is Gram-stain positive, partially acid-fast and anaerobic. Very few cases of human infection due to this organism are described and here we seek to add to the limited medical literature. We report the case of a 2-year-old girl who presented with an infected spinal dermoid cyst secondary to Lawsonella clevelandensis which required surgical drainage and a long course of antibiotics. We encountered diagnostic and therapeutic difficulties because this is a fastidious organism which was difficult to culture and ultimately required molecular detection and identification. To the best of our knowledge, this is only the seventh reported case of Lawsonella clevelandensis causing human infection worldwide and the first in the UK. This is the first reported case of Lawsonella clevelandensis infection in a child and the second reported case of this organism causing spinal infection.
Assuntos
Actinobacteria , Empiema Subdural , Criança , Feminino , Humanos , Pré-Escolar , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/cirurgia , Coluna VertebralRESUMO
BACKGROUND: To describe clinical presentations of intracranial sinusitis complications in childhood, their pitfalls and imaging findings. MATERIEL AND METHODS: This retrospective IRB-approved single-center study included infants diagnosed with sinusitis and empyema and/or other intracranial complications who underwent imaging between September 2008 and September 2019. Three radiologists individually reviewed clinical charts and imaging findings, including sinusitis complications and at-risk anatomical variations. RESULTS: 21 children (76% males and 24% females, mean age 13±3.1 years) with imaging pansinusitis were included. Headache (95%) and fever (90%) were the main clinical nonspecific signs. Ten (48%) children presented an extradural empyema, nine (43%) children had a subdural empyema and two (10%) children had both. Frontal location sinusitis was the most common (76%). In MRI, all empyema presented as a hypo intensity on pre-contrast T1-WI, a hyperintensity on T2-WI, a reduced apparent diffusion coefficient (ADC) on diffusion weighted imaging (DWI) and a peripheral contrast enhancement on post-contrast T1-WI. CT or MRI revealed intracranial complications such as a collection size increase (52%), a midline shift (62%), intraparenchymal abscesses (24%), a cerebral venous thrombosis (29%), an intracranial pressure increase (29%), cerebral ischemia (43%) and Pott's Puffy Tumor (10%). Imaging highlighted sinus anatomical abnormalities in 52% of cases. All children were treated with sinus drainage and/or neurosurgery. Long-term follow-up was favorable in 14 cases (67%). CONCLUSION: Complications of sinusitis are life threatening in the studied population. Empyema and cerebral complications may be misleading. Brain contrast-enhanced CT covering sinuses and orbits, is mainly the first examination done but MRI is mandatory.
Assuntos
Empiema Subdural , Abscesso Epidural , Sinusite Frontal , Adolescente , Criança , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/epidemiologia , Empiema Subdural/etiologia , Feminino , Sinusite Frontal/complicações , Sinusite Frontal/diagnóstico por imagem , Sinusite Frontal/epidemiologia , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Masculino , Estudos RetrospectivosRESUMO
Central nervous system (CNS) involvement by actinomycosis is rare, seen in 2%-3% cases. It mostly spreads to CNS by haematogenous route from a distant primary site such as oral cavity, lung, abdomen or pelvis. Direct CNS extension can also occur. It mostly presents as brain abscess, meningoencephalitis, actinomycetoma, subdural empyema and epidural abscess. We report one case of extensive actinomycosis having intra and extraparenchymal CNS, spinal canal, retropharyngeal and mediastinal involvement. Due to such widespread extension and involvement of vital areas, complete surgical debulking was not possible. In addition to therapeutic resistance to conventional antibiotics, repetitive negative cultures posed significant difficulty in the case management.
Assuntos
Actinomicose , Abscesso Encefálico , Empiema Subdural , Abscesso Epidural , Meningoencefalite , Actinomicose/diagnóstico por imagem , Actinomicose/tratamento farmacológico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/tratamento farmacológico , HumanosRESUMO
A 55-year-old man was taken to the emergency department due to right arm weakness for the past 3 days and fever (39.5°C). There was no impaired consciousness, no history of trauma and meningeal signs were absent on physical examination. Blood analysis and inflammatory markers were not evocative of a systemic infection. A cranial CT scan was requested, revealing hypodense bilateral hemispheric subdural collections, suggestive of chronic subdural haematomas. He was submitted to surgical drainage by burr holes, which confirmed the chronic subdural collection on the left side. Unexpectedly, after dural opening on the right side, a subdural purulent collection was found, which was later confirmed as an empyema due to Escherichia coli infection. A second surgical drainage was performed by craniotomy due to recurrence of the right subdural collection. Spontaneously appearing subdural empyemas due to E. coli are extremely rare and their treatment is not always straightforward. The reported case is an example of an apparently straightforward and frequent pathology that turned out to be a challenging case, requiring a multidisciplinary approach.
Assuntos
Empiema Subdural , Hematoma Subdural Crônico , Craniotomia , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/cirurgia , Escherichia coli , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Subdural/diagnóstico por imagem , Espaço Subdural/cirurgiaAssuntos
Doenças do Cão , Empiema Subdural , Hematoma Subdural Crônico , Animais , Progressão da Doença , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/etiologia , Cães , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/veterinária , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/veterinária , Tomografia Computadorizada por Raios XRESUMO
The term "intracranial abscess" (ICA) includes cerebral abscess, subdural empyema, and epidural empyema, which share many diagnostic and therapeutic similarities and, frequently, very similar etiologies. Infection may occur and spread from a contiguous infection such as sinusitis, otitis, mastoiditis, or dental infection; hematogenous seeding; or cranial trauma. In view of the high morbidity and mortality of ICA and the fact that hyperbaric oxygen therapy (HBO2) is relatively non-invasive and carries a low complication rate, the risk-benefit ratio favors adjunct use of HBO2 therapy in selected patients with intracranial abscess.
Assuntos
Abscesso Encefálico/terapia , Oxigenoterapia Hiperbárica/métodos , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/etiologia , Empiema Subdural/terapia , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/etiologia , Abscesso Epidural/terapia , Humanos , Seleção de Pacientes , Medição de Risco , Infecções Estreptocócicas/microbiologiaRESUMO
PURPOSE: Due to the generalization of new microsurgical equipment, intraoperative fluorescence techniques have extended in neurosurgical practice, mainly in neurovascular and neuro-oncology patients. The aim of identifying pathological tissue and also differentiating from the normal brain helps neurosurgeons to approach other kinds of intracranial entities such as infections. METHODS: It is described in the case of an 11-year-old patient who underwent a subdural empyema by performing a craniotomy and evacuation of the purulent collection. After a non-optimal evolution, a frontobasal meningoencephalitis was assessed with cerebral involvement and associated intracranial hypertension. Indocyanine green (ICG) was used in reintervention for demonstrating a great damage of cortical vascularization around the infected area as well as fluorescein (FL), which identified a large area of avascularized tissue. RESULTS: Both techniques allowed a selective excision of the affected brain parenchyma while preserving viable parenchymal areas. Radiological evolution and clinical outcome were good. CONCLUSIONS: The identification of vascular patterns in brain lesions and the recognition of viable or necrotized tissues are suitable for a selective resection of the parenchyma, minimizing morbidity. Clinical outcome is related to a safe and effective management of inflammatory and infectious processes.
Assuntos
Empiema Subdural , Verde de Indocianina , Criança , Craniotomia , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/cirurgia , Fluoresceína , Fluorescência , HumanosRESUMO
BACKGROUND: Chronic calcified subdural empyema is an exceedingly rare central nervous system infection with a handful of cases published to date. Reported cases presented with nonspecific clinical signs and symptoms. The duration between the initial onset of symptoms and diagnosis can vary drastically from a few years to up to 46 years. Although there are known predisposing causes, the initial source of infection can sometimes be difficult to identify. CASE PRESENTATION: Our patient was a 39-year-old Ethiopian man who presented with left-side body weakness of 6 years' duration with worsening of symptoms of 6 months' duration. He had no history of trauma, meningitis, or previous surgery. The results of routine laboratory tests were normal. The diagnosis was made by computed tomography and magnetic resonance imaging and was confirmed by surgery. Frontoparietal craniotomy was performed, and evacuation of non-foul-smelling collection was done. The patient was reoperated for tension pneumocephalus 48 hours after the initial surgery. He died 10 days later. CONCLUSION: This is a rare case of a giant chronic calcified subdural empyema with no known preceding history of trauma or infection.
Assuntos
Calcinose/etiologia , Empiema Subdural/etiologia , Adulto , Calcinose/diagnóstico por imagem , Calcinose/patologia , Calcinose/cirurgia , Craniectomia Descompressiva , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/patologia , Empiema Subdural/cirurgia , Evolução Fatal , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Purulent intracranial infections are threatening conditions. Different surgical approaches have been described, respecting the rationale of evacuating the fluid component of the purulent collection. Emerging evidence supports the use of the endoscope for the treatment of cerebral abscesses and subdural empyemas; especially the peculiarities of flexible endoscopes could potentially offer a more effective and conclusive management as compared with the drainage through catheters. We describe our experience in the treatment of intracranial purulent collections with flexible endoscopy, comparing it with the most recent literature. METHODS: Ten patients affected by intracranial suppuration were treated with endoscopy at our institution. The neurosurgical technique is thoroughly described. The related literature is reviewed, providing a comprehensive overview on the endoscopic treatment of intracranial suppuration so far. RESULTS: All the patients had a good clinical outcome, with no peri-operative complications. The postoperative scans showed significant radiological improvement, with important reduction of the pus volume. In all cases, the microbiological cultures showed positivity. CONCLUSIONS: In our experience, the use of the flexible scope proved feasible and effective in the treatment of intracranial purulent collections. Visual awareness of the internal capsule is not limited to a direct inspection of the fluid pus; it rather allows an active removal of the more solid (and perhaps more microbiologically significant) fibrinoid component, and also assists in final bleeding control and in assessing the extent of the evacuation. The steering capabilities of the fiberscope are particularly suitable for such purposes, allowing sampling the solid internal layer of the pyogenic membrane, and potentially shedding light on the actual clinical significance of this component of the abscess.
Assuntos
Abscesso Encefálico/cirurgia , Drenagem/métodos , Empiema Subdural/cirurgia , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Empiema Subdural/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Clinical worsening or new manifestation of cryptococcal disease following initiation of anti-retroviral therapy (ART) in an HIV patient is a hallmark of cryptococcal immune reconstitution inflammatory syndrome (C-IRIS). However, it can be difficult to distinguish IRIS from worsening or new infection. Here, we present a case of severe C-IRIS involving multiple cerebellar, spinal, and intradural abscesses and spinal arachnoiditis 7 months after ART initiation in an AIDS patient with uncertain prior ART compliance. He had multiple prior episodes of cryptococcal meningitis with complications necessitating ventriculoperitoneal shunt placement and was on suppressive fluconazole when he developed worsening brain manifestations. He received empiric anti-cryptococcal re-induction without improvement. All cerebrospinal fluid cultures remained sterile, with negative Cryptococcus PCR testing, and his condition continued to worsen prior to corticosteroid initiation. Ultimately, C-IRIS was diagnosed by brain biopsy. This case demonstrates an extreme in severity of C-IRIS and in the timeline of presentation after ART initiation.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Antirretrovirais/uso terapêutico , Antifúngicos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Empiema Subdural/diagnóstico por imagem , Síndrome Inflamatória da Reconstituição Imune/diagnóstico por imagem , Meningite Criptocócica/tratamento farmacológico , Anfotericina B/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Aracnoide-Máter/patologia , Aracnoidite/congênito , Aracnoidite/diagnóstico por imagem , Aracnoidite/tratamento farmacológico , Biópsia , Encéfalo/patologia , Abscesso Encefálico/tratamento farmacológico , Edema Encefálico/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/tratamento farmacológico , Empiema Subdural/tratamento farmacológico , Fluconazol/uso terapêutico , Flucitosina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , RecidivaRESUMO
RATIONALE: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. However, complicated subdural empyema rarely occurs after trepanation and drainage of chronic subdural hematoma. PATIENT CONCERNS: A male patient (77 years old) was admitted to the hospital on the 2nd day of fever after an undergoing a "trepanation and drainage of chronic subdural hematoma" operation at a local hospital. After admission, the patient was treated with an emergency operation in which a subdural abscess was diagnosed and then administered antibiotics after the operation. DIAGNOSIS: According to the clinical manifestations, intraoperative findings of imaging examination and the results of pus culture, the diagnosis was subdural empyema. INTERVENTION: We surgically removed the subdural empyema. Postoperative antibiotics were administered according to the results of bacterial culture. OUTCOMES: At 3 months after the operation, the patient returned to the hospital for reexamination and was found to have achieved a good recovery and good self-care. LESSONS: Subdural empyema after trepanation and drainage of chronic subdural hematoma is a very rare and severe disease. Early diagnosis and operative intervention as well as the intravenous administration of antibiotics can improve the prognosis of patients and enhance their quality of life.
Assuntos
Empiema Subdural/etiologia , Hematoma Subdural Crônico/cirurgia , Trepanação , Idoso , Encéfalo/diagnóstico por imagem , Empiema Subdural/diagnóstico , Empiema Subdural/diagnóstico por imagem , Humanos , Masculino , Neuroimagem , Tomografia Computadorizada por Raios X , Trepanação/efeitos adversos , Trepanação/métodosRESUMO
OBJECTIVE: The authors conducted a retrospective analysis of a consecutive series of children with intracranial subdural empyemas (SEs) and epidural abscesses (EAs) to highlight the important clinical difference between these two entities. They describe the delays and pitfalls in achieving accurate diagnoses and make treatment recommendations based on clinical and imaging findings. METHODS: They reviewed their experience with children who had presented with intracranial SE and/or EA in the period from January 2013 to May 2018. They recorded presenting complaint, date of presentation, age, neurological examination findings, time from presentation to diagnosis, any errors in initial image interpretation, timing from diagnosis to surgical intervention, type of surgical intervention, neurological outcome, and microbiology data. They aimed to assess possible causes of any delay in diagnosis or surgical intervention. RESULTS: Sixteen children with SE and/or EA had undergone evaluation by the authors' neurosurgical service since 2013. Children with SE (n = 14) presented with unmistakable evidence of CNS involvement with only one exception. Children with EA alone (n = 2) had no evidence of CNS dysfunction. All children older than 1 year of age had sinusitis. The time from initial presentation to a physician to diagnosis ranged from 0 to 21 days with a mean and median of 4.5 and 6 days, respectively. The time from diagnosis to neurosurgical intervention ranged from 0 to 14 days with a mean and median of 3 and 1 day, respectively. Delay in treatment was due to misinterpretation of images, a failure to perform timely imaging, progression on imaging as an indication for surgical intervention, or the managing clinician's preference. Among the 14 cases with SE, initial imaging studies in 6 were not interpreted as showing SE. Four SE collections were dictated as epidural even on MRI. The only fatality was associated with no surgical intervention. Endoscopic sinus surgery was not associated with reducing the need for repeat craniotomy. CONCLUSIONS: Regardless of the initial imaging interpretation, any child presenting with focal neurological deficit or seizures and sinusitis should be assumed to have an SE or meningitis, and a careful review of high-resolution imaging, ideally MRI with contrast, should be performed. If an extraaxial collection is identified, surgical drainage should be performed expeditiously. Neurosurgical involvement and evaluation are imperative to achieve timely diagnoses and to guide management in these critically ill children. ABBREVIATIONS: EA = epidural abscess; SE = subdural empyema.
Assuntos
Diagnóstico Tardio , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/cirurgia , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/cirurgia , Tempo para o Tratamento , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Erros de Diagnóstico , Empiema Subdural/complicações , Abscesso Epidural/complicações , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Meningites Bacterianas/tratamento farmacológico , Estudos Retrospectivos , Sinusite/complicações , Sinusite/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Necrotising otitis externa (NOE) is an infection originating in the soft tissues of the external auditory canal (EAC) spreading to the surrounding bone and rarely causing intracranial complications. It is usually caused by Pseudomonas aeruginosa and has historically occurred in elderly patients with diabetes or immunodeficiency. EAC foreign body is a risk factor for otitis externa but has not been described in NOE. A healthy 31-year-old man presented with new-onset seizures and worsening left-sided otalgia and otorrhoea. Brain imaging revealed left temporal subdural abscesses superior to the petrous bone. A retained cotton bud was identified in the left EAC, along with osseocartilaginous junction and mastoid granulation tissue. The foreign body was removed; a cortical mastoidectomy performed and intravenous antibiotic administered. At 10 weeks, the patient remained well, with no neurological deficit and no residual ear symptoms, and CT demonstrated complete resolution of the intracranial abscesses.
Assuntos
Meato Acústico Externo/microbiologia , Empiema Subdural/etiologia , Otite Externa/microbiologia , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Meato Acústico Externo/patologia , Otopatias/complicações , Dor de Orelha/diagnóstico , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/tratamento farmacológico , Corpos Estranhos , Tecido de Granulação , Humanos , Masculino , Processo Mastoide/patologia , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Necrose/patologia , Otite Externa/diagnóstico , Otite Externa/tratamento farmacológico , Otite Externa/patologia , Convulsões/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
A case report of a 94-year-old, previously well male patient who presented with fever thought to be caused by community acquired pneumonia, new unilateral hearing loss and reduced consciousness. Despite antibiotic treatment he continued to deteriorate. Brain imaging with computer tomography and magnetic resonance imaging revealed a left otomastoiditis with osteomyelitis of the skull base, associated with an adjacent subdural empyema. He was also found to have a venous sinus thrombosis, most likely secondary to otitis media. He was managed with intravenous antibiotics, anticoagulation, grommet insertion and a hearing aid and he made a good recovery. This case reminds us to consider otitis media in older patients who present with hearing loss and fever. Otitis media can lead to serious complications including subdural empyema and osteomyelitis of the skull base.
Assuntos
Perda Auditiva Unilateral/etiologia , Mastoidite/diagnóstico por imagem , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Empiema Subdural/complicações , Empiema Subdural/diagnóstico , Empiema Subdural/diagnóstico por imagem , Perda Auditiva Unilateral/diagnóstico , Perda Auditiva Unilateral/diagnóstico por imagem , Perda Auditiva Unilateral/terapia , Humanos , Masculino , Mastoidite/complicações , Mastoidite/diagnóstico , Neuroimagem , Otite Média/complicações , Otite Média/diagnóstico , Otite Média/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Encefalopatias , Empiema Subdural , Antibacterianos/uso terapêutico , Encefalopatias/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Encefalopatias/cirurgia , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/tratamento farmacológico , Empiema Subdural/cirurgia , Humanos , Imageamento por Ressonância Magnética , Procedimentos NeurocirúrgicosRESUMO
INTRODUCTION: Intracranial complications of acute rhinosinusitis are rare, but may turn life-threatening. CASE SUMMARY: We report a healthy 30-year-old male who complained of frontal headache, which developed while on a plane. A brain CT showed a low-density lesion on the left frontal convexity with right maxillary and ethmoid sinusitis. Despite receiving intravenous antibiotics, a follow-up brain CT showed two lesions with adjacent dural and leptomeningeal enhancement. A paranasal sinus CT revealed aggravated left frontal sinusitis and right maxillary sinusitis. The patient underwent craniotomy and brain abscess removal along with endoscopic sinus surgery. Seventeen days after the surgery, the patient was discharged with no neurological sequelae. CONCLUSION: To the best of our knowledge, this case is the first report regarding the association between barotrauma and intracranial complications of acute rhinosinusitis. A high index of suspicion and well-timed surgical evacuation may ensure a full recovery.