11/653. headache: cortical vein thrombosis and response to anticoagulation. Cerebral venous thrombosis (CVT) is being diagnosed more frequently with the use of advanced radiologic imaging. The presentation of CVT includes a wide spectrum of nonspecific symptoms with headache predominating. We present a case with acute, severe headache. The evaluation included a head computed tomography (CT) scan that was normal. The presence of opacified sinuses led to treatment for sinusitis. The patient returned the following day with a generalized tonic-clonic seizure. A magnetic resonance imaging (MRI) study identified an isolated cortical venous thrombosis. This patient was treated with anticonvulsant and anticoagulation therapy. A CVT is an unusual cause of headache and should be considered in patients with atypical presentation or associated seizure, or who are refractory to current therapy. diagnosis may be made with MRI. Resolution and complete recovery are possible with appropriate therapy. ( info) |
| A 15-year-old girl developed end-stage renal disease requiring renal transplantation. Posttransplantation immunosuppression therapy consisted of antithymocyte globulin, glucocorticosteroids, cyclosporine A, and azathioprine. The patient's clinical course after transplantation was complicated by several episodes of graft rejection, chronic anemia, oral candidiasis, and numerous infections of the sinopulmonary tract that were recalcitrant to antibiotics and surgical intervention. An immunologic evaluation showed marked immune abnormalities beyond that expected by the transplant immunosuppression. Examination of serum samples taken before the transplant confirmed a diagnosis of common variable immunodeficiency. The difficulties of managing posttransplantation immunosuppression in a patient with a primary immunodeficiency are discussed. patients with end-stage renal disease and a history of recurrent sinopulmonary infections may require immunologic screening before renal transplantation. ( info) |
13/653. brain abscess caused by cladosporium trichoides (Bantianum): a case with paranasal sinus involvement. Dematiacious fungi (ie, fungi with dark hyphae) are a rare and usually fatal cause of central nervous system infection. cladosporium trichoides has been implicated most frequently. documentation of extra-CNS involvement has been rare. Our patient had a brain abscess and paranasal sinus infection due to C trichoides. The organism was sensitive to less than or equal 2mug/ml of flucytosine. Although our patient did not receive flucytosine, it is possible that this drug, because of its excellent penetration into the cerebrospinal fluid, may be a useful therapeutic agent in cerebral cladosporiosis. ( info) |
14/653. The use of standardized orbital ultrasound in the diagnosis of sinus induced infections of the orbit in children: a preliminary report. Infections of the orbit in children usually present as a complication of sinusitis and may result in blindness or even death. orbital cellulitis (OC) and subperiosteal abscess (SPA) represent different pathologies within the spectrum of orbital infections. The differentiation between OC and SPA is important, since it implies two different therapeutic modalities. While SPA is usually treated by incision and drainage and parenteral antibiotics, OC may be treated with antibiotics alone. Contrast enhanced CT scan is commonly used in the diagnosis of orbital infections, but does not always prove accurate in differentiating between these two conditions. MRI is superior to CT in the resolution of soft tissue pathology and may be more precise in such situations, but is less available imaging tool outside north america and europe. There have been a few reports in the early 1980's on the use of standardized orbital ultrasound (SOU) in these two conditions. We have used SOU in seven children with sinus induced orbital infections--four with SPA and three with OC. We reviewed our experience in these patients and compared the imaging characteristics of OC and SPA on SOU with those of conventional imaging modalities, used in orbital infections. In four of the cases, CT scan was inconclusive, while SUO was diagnostic. In this preliminary report, we conclude that SOU may be useful in the diagnosis of orbital infections. ( info) |
15/653. Allergic fungal sinusitis-induced visual loss. In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed allergic fungal sinusitis from 1989 to 1997. Of this group, three patients presented with visual loss and were treated with prompt surgical decompression followed by immunomodulation. ( info) |
16/653. Non-randomized comparison of surgical modalities for paranasal sinus mycoses with intracranial extension. Mycotic infections of paranasal sinuses are frequently reported in southern asia. aspergillus and mucor species are the predominant ones. Intracranial extension of paranasal sinus mycoses is a difficult problem to manage. We report 18 cases of paranasal sinus mycoses with intracranial extensions. The commonest manifestations were nasal discharge (67%), nasal obstruction (50%), ocular symptoms such as proptosis (44%), telecanthus (39%) and ophthalmoplegia. Computerized tomography scans were found to be quite informative regarding the nature and extent of the disease (100% sensitivity and 78% specificity). A combined intracranial-extracranial approach (six cases) gave a distinct advantage over only adopting an extracranial approach (12 cases). A 17% incidence of CSF leak was noted by adopting only an extracranial approach as well as a recurrence in four cases out of the 12 that were treated using this method (P < 0.05). A slight increase in morbidity was associated with the combined intracranial-extracranial treatment, but no recurrence or significant complications were noted in this approach. ( info) |
17/653. Severe steroid-dependent asthma with IgG-2 deficiency and recurrent sinusitis: response to treatment with high-dose intravenous immunoglobulin. patients with severe asthma pose a dilemma to the physician since the treatment they need, namely high doses of oral steroids, has serious side effects, especially among the pediatric population. Deficiency in one or more of the IgG subclasses has been associated with abnormal pulmonary function, as well as with recurrent sinopulmonary infections in adults and children. In the last years attention has been focused on alternative therapies for these patients. One of these alternatives is the treatment with intravenous immunoglobulin (IVIG). We report an 11-year-old boy with severe asthma since the age of two years and multiple hospital admissions due to asthmatic crisis even more frequent and severe, to the point of needing, in the last year, daily treatment with high doses of oral steroids (20 mg). During six months the patient was given high doses of intravenous immunoglobulin. After one month of treatment a clinical and spirometric improvement was apparent allowing to taper down the oral steroids until their complete substitution by inhaled budesonide (1,600 microg/day). The only side effects noted were severe headaches after gammaglobulin infusions which responded well to oral paracetamol. This improvement was sustained throughout the treatment period, but few weeks after the IVIG was suspended the clinical and spirometric parameters started to worsen again. ( info) |
18/653. Acute angle closure glaucoma precipitated by intranasal application of cocaine. We describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwent an elective antral washout under general anaesthesia and with local application of 25 per cent cocaine paste to the nasal mucosa. Twenty-four hours post-operatively the patient developed sudden painful blindness which was found to be due to acute glaucoma. cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glaucoma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential complication. ( info) |
19/653. A possible mechanism of primary ciliary dyskinesia: a case of a segmental defect in ciliary microtubules. We report here a 13-year-old woman with cough, sputum and fever. The patient had both chronic sinusitis and bronchitis. Chest X-ray and computed tomographic scan of the chest revealed mucous bronchial filling and bronchiectasia in bronchi of bilateral lower lobes, right middle lobe and left upper lobe. Aerosol inhalation scintigraphy with 99mTechnetium demonstrated delays of the discharged tracer. On the basis of these findings, primary ciliary dyskinesia was suggested. This was confirmed by the findings from nasal biopsy with transmission electron microscopy where all of the microtubules were segmentally defected near the basal body in the cilia. On the basis of these findings, we diagnosed the patient with primary ciliary dyskinesia which may be due, at least in part, to segmental defect of ciliary microtubules. ( info) |
20/653. Papilloedema secondary to acute purulent sinusitis. Upper respiratory tract infections and sinusitis are common, but intracranial complications of sinusitis are rare in children and are often clinically unremarkable. Papilloedema secondary to purulent sinusitis is a complication previously not reported. We report two cases to highlight atypical manifestations of sinusitis in children. ( info) |