Causal Relationship Between Chronic Upper Respiratory Infections and Benign Enlargement of Subarachnoid Spaces

Benign enlargement of subarachnoid spaces (BESS) is a common clinical finding in pediatric patients. Although a few causes have been put forward, the etiology of the enlargement is largely unknown. Both chronic upper respiratory infections (URI’s) and cor pulmonale (by means of increased right atrial pressure) can hinder venous drainage contributing to increased cerebrospinal fluid (CSF) volume and elevated intracranial pressure (ICP), thus potentially predisposing a patient to enlargements of their subarachnoid spaces to accommodate for these changes. This study aims to determine if a history of chronic upper respiratory infections and cor pulmonale is correlated to a higher incidence of BESS. Scans and medical records from patients under the age of 2 with either macrocephaly or BESS from 2009-2016 were examined to evaluate this possible association. Incidences of chronic URIs and elevated RAP were statistically significantly higher in the BESS population supporting the proposed aim of the study (p<0.001). Physicians should consider closely monitoring patients with chronic URIs and cor pulmonale for possible BESS and associated sequelae.