Sahjpaul R L, Lee D H
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
Neurosurgery. 1999 Apr;44(4):864-6; discussion 866-8. doi: 10.1097/00006123-199904000-00101.
Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man.
A 26-year-old man with a remote history of sinusitis developed rapidly progressive headache, fever, right eye pain, swelling, proptosis, and visual impairment. Magnetic resonance imaging demonstrated diffuse pansinusitis, including sphenoid sinusitis, and extension of inflammation and infection into the adjacent cavernous sinuses, pituitary gland, and posterior fossa.
Urgent drainage of the ethmoid and maxillary sinuses was performed; pus was not identified. The patient continued to deteriorate clinically with worsening of visual acuity. Computed tomography of the head performed the next day revealed worsening hydrocephalus and an enlarging posterior fossa subdural empyema. Urgent ventricular drainage and evacuation of the empyema was performed, and subsequently, the patient's clinical course improved. The microbiology results revealed alpha hemolytic streptococcus and coagulase-negative staphylococcus species. The patient survived but during the follow-up period had a blind right eye and pituitary insufficiency.
Paranasal sinusitis can have devastating intracranial sequelae. Involvement of the adjacent pituitary gland and cavernous sinuses can result in serious neurological morbidity or mortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvement. A high index of suspicion and aggressive medical and surgical treatment are crucial for patient survival, but the morbidity rate remains high. Our patient survived but lost anterior pituitary function and vision in his right eye.
幕下积脓、垂体脓肿和化脓性海绵窦血栓性静脉炎均为罕见且可能致命的病症。此前尚未有过同一患者同时出现这三种病症的报道。我们在此呈现一名年轻且原本健康男性身上发生的此类病例。
一名有鼻窦炎既往史的26岁男性，出现迅速进展的头痛、发热、右眼疼痛、肿胀、眼球突出及视力损害。磁共振成像显示弥漫性全鼻窦炎，包括蝶窦炎，炎症和感染蔓延至相邻的海绵窦、垂体及后颅窝。
紧急进行筛窦和上颌窦引流；未发现脓液。患者临床症状持续恶化，视力进一步下降。次日进行的头部计算机断层扫描显示脑积水加重，后颅窝硬膜下积脓增大。紧急进行脑室引流和积脓清除，随后患者的临床病程有所改善。微生物学检查结果显示为甲型溶血性链球菌和凝固酶阴性葡萄球菌。患者存活，但在随访期间右眼失明且出现垂体功能不全。
鼻窦炎可引发严重的颅内后遗症。累及相邻的垂体和海绵窦可导致严重的神经功能障碍或死亡，感染通过基底静脉系统逆行扩散可导致硬膜下或脑实质受累。高度的怀疑意识以及积极的药物和手术治疗对患者存活至关重要，但发病率仍然很高。我们的患者存活下来，但失去了垂体前叶功能和右眼视力。
