Can a Sinus Infection (Rhinosinusitis) Cause Spinal Meningitis?
The answer is unfortunately. Yes!
Meningitis, sometimes referred as spinal meningitis, is an inflammation of the membranes surrounding the brain and spinal cord. Usually caused by a viral infection, but it can also be caused by a bacterial or fungal infection.
Among pediatric patients admitted for treatment of sinusitis, 3.2% were found to have an intracranial complication. Infection of the sphenoid sinuses, however, merits concern. These thin-walled sinuses develop late in childhood, and their deep location places them adjacent to the dura mater and other critical structures.
Sphenoid sinusitis is identified in approximately 3% of cases of acute sinusitis, typically in the context of pansinusitis. Significant development of the sphenoid sinuses does not begin until age 4 to 6 years, thus, sphenoid sinusitis is restricted.
Viral infection causes most cases of spinal meningitis. Viral meningitis is usually mild and heals without treatment. Bacterial meningitis is more severe and requires treatment with antibiotics. Streptococcus pneumoniae and neisseria meningitidis are strains of bacteria that cause pneumococcus and meningococcus meningitis respectively.
It can be life threatening condition owing to its proximity to brain and spinal cord and infective media is the fluid surrounding them.
Diagnostic tools:
• Lumbur puncture – csf examination (cell count, glucose, proteins) and culture
• Blood culture
• Chest x ray
• CT scan of head and nose – pns
• MRI brain
Symptom checker in meningitis secondary to sinusitis:
• Fever (92%)
• Headache (85%)
• Nausea, vomiting (62%)
• Altered consciousness (31%)
• Seizure (31%)
• Hemiparesis (23%)
• Visual disturbance (23%)
• Meningismus (23%)
Conclusion and quick pearls:
• Complications that are less common with antibiotics
• Orbital (cellulitis, abscess)
• Intracranial (subdural empyema, thrombosis of cavernous sinus)
• Bony osteomyelitis.
• Can result in drastic sequelae
• Drain abscess and open involved sinuses
• Ent surgical involvement – functional endoscopic sinus surgery
- Usually amenable with medical treatment
- Drain sinuses if no improvement after 48 hours
• Ophthalmology check up
• Neurosurgery intervention
A low index of suspicion is necessary for early diagnosis and treatment of sphenoid sinusitis, orbital complications and prevention of intracranial complications including meningitis.
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