RESUMO
An 81-year-old man with unilateral nasolacrimal duct obstruction underwent routine endonasal dacryocystorhinostomy and 2 days postoperatively developed a severe headache and rigors. Subsequent CT and MRI imaging demonstrated a defect in the floor of the right anterior cranial fossa, which possibly was damaged during the operation, and meningoencephalitis of the adjacent frontal lobe gyrus. Following intravenous antibiotic treatment, the patient made a full recovery with no ongoing sequelae, and his epiphora completely resolved. To the authors' knowledge, this is the first report of meningoencephalitis following endonasal dacryocystorhinostomy. This complication should be considered in any patient with a febrile septic presentation or headache following endonasal dacryocystorhinostomy.
Assuntos
Dacriocistorinostomia/efeitos adversos , Endoscopia/efeitos adversos , Doenças do Aparelho Lacrimal/cirurgia , Meningoencefalite/etiologia , Infecções Estafilocócicas/etiologia , Infecção da Ferida Cirúrgica/etiologia , Idoso de 80 Anos ou mais , Dacriocistorinostomia/métodos , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Tomografia Computadorizada por Raios XRESUMO
The provision of health services in Australia currently is primarily financed by a unique interaction of public and private insurers. This commentary looks at a loophole in this framework, namely that private insurers have to date been able to avoid funding healthcare for some of their policy holders, as it is not a requirement to use private insurance when treatment occurs in Australian public hospitals.