Abstract

Introduction: Sinusitis is a prevalent, typically benign condition, yet uncommon but severe complications, including intracranial infection and death, may occur if cases go unrecognized and are not promptly and appropriately treated. This report presents a rare case of acute sinusitis that ultimately resulted in subdural empyema and death in a 22-year-old woman.
Case Description: A 22-year-old woman initially presented to the emergency department with acute onset of headache and fever. Workup revealed pyogenic meningitis, likely secondary to acute sinusitis. Her condition quickly deteriorated with repeated seizures requiring continuous EEG monitoring. MRI revealed findings compatible with acute bilateral frontal subdural empyema. The patient underwent endoscopic sinus surgery with image guidance for drainage of the empyema. The patient became apneic shortly after the surgical procedure; a repeat CT revealed diffuse cerebral edema and she died despite external ventricular drainage.
Conclusion: Though common and mostly benign, acute sinusitis can lead to disastrous outcomes if the infection spreads to adjacent structures and becomes an intracranial process. Progression can be rapid. Management typically involves broad-spectrum antibiotics as well as surgical debridement and intervention. Subdural empyema, a rare complication of sinusitis, should be suspected if there is clinical evidence of mental status change, meningeal signs, focal neurological findings, or seizures. Interventions, including medications, the timing of surgery, and surgical approach, need to be optimized via collaborative efforts of all physicians and surgeons involved in caring for the patient. A high index of suspicion is the first step in arriving at a correct diagnosis to improve patient outcomes.

Keywords:Sinusitis; Bacterial sinusitis; Meningitis; Empyema; Subdural empyema; Case report