[Cranioencephalic complications of bacterial sinusitis in children and adolescents: eight cases in Libreville (Gabon)].

Abstract

Objective: To review the pathologic, diagnostic and therapeutic aspects of the cranioencephalic complications of bacterial sinusitis.

Material and methods: This retrospective study included children who underwent diagnostic imaging at the Omar Bongo Ondimba military hospital between January 2006 and December 2010 and treatment of cranioencephalic complications of sinusitis.

Results: During the study period, 58 children were hospitalized with sinusitis, and eight (13.8%) had cranioencephalic complications for an annual incidence of 1.6% and a sex ratio of 5 boys to 3 girls. Their mean age was 13 years. Symptoms developed over a mean duration of 14 days (range: 3-45 days). The clinical picture was dominated by febrile headaches and neurologic signs. Palpation of the sinus pressure points was painful in all cases. Disorders of consciousness were found in five cases, with a mean Glasgow score of 9 (range: 7-13). Seven children had multifocal sinusitis and one frontal sinusitis. Five children had a subdural empyema, two associated with thrombophlebitis of the sagittal sinus, one with a brain abscess with thrombophlebitis of the sagittal sinus, and another with meningitis and thrombophlebitis of the sagittal sinus. Two children had osteomyelitis of the frontal sinus table, including a frontal lobe abscess for one. Another had multiple cerebral abscesses. Five children had sinus and neurosurgical drainage, two sinus drainage only, and one neurosurgical drainage only. Microbiology was positive for microbes in four cases: Streptococcus eqinus (one case), Staphylococcus aureus (one case), both S. pneumoniae and Haemophilus influenzae (one case), and Aerococcus viridans (one case). Outcome was favourable in seven cases, including four without sequelae. Two children had recurrences, and one died.

Conclusion: Diagnosis of the cranioencephalic complications of sinusitis rely on medical imagery. Early multidisciplinary therapeutic management is essential.