Background. Sinogenic intracranial empyema (SIE) is an uncommon complication of sinusitis that can lead to devastating neurologic sequelae. Early recognition of the clinical findings is critical so that proper management can be instituted.Objective. To describe the symptoms, signs, and laboratory and imaging findings from one of the largest pediatric SIE case series reported.Methods. Descriptive study of a retrospective cohort of all children admitted to Primary Children's Medical Center with SIE between June 2000 and February 2004. Children were identified by a computerized search of Primary Children's Medical Center medical records using the terms “sinusitis” and “brain/subdural/epidural empyema.” Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values of children with SIE were compared with a group of children with uncomplicated sinusitis cared for in the same health care system as outpatients. The medical records of the uncomplicated sinusitis group were not reviewed for any clinical or radiographic data other than CRP and ESR values.Results. Twelve children with SIE were identified. The median age of children with SIE was 11.5 years. Symptoms were usually present 10 days (median) before diagnosis and included headache (10), fever (11), nausea/vomiting (7), mental-status changes (5), and seizures (3). Physical findings included abnormal neurologic examination (9), Pott's puffy tumor (4), and orbital cellulitis (3). Using the Intermountain Health Care system's computerized database, 142 children with uncomplicated sinusitis treated as outpatients were identified. Children with SIE had markedly higher CRP levels (median: 10.05 mg/dL) and ESRs (median: 87 mm/hour) than those with uncomplicated sinusitis (median CRP: 0.7 mg/dL; median ESR: 6 mm/hour). Four children had hyperglycemia. Four children had a lumbar puncture at presentation, and the findings were normal for all of them. Craniofacial imaging included computed tomography (CT) and magnetic resonance imaging (MRI). SIE was not detected in 4 patients who had nonenhanced CT. Axial imaging alone was unable to demonstrate SIE in 1 child with sphenoid and ethmoid sinusitis, and coronal images were needed to demonstrate its presence and extent. The initial facial/orbital imaging studies in 2 patients with physical signs of complicated sinusitis (orbital cellulitis and Pott's puffy tumor) were not adequate to detect SIE. Using contrast-enhanced head CT or MRI, SIE was diagnosed in all 12 children.Conclusions. Children with sinusitis and any neurologic finding, signs of complicated sinusitis such as Pott's puffy tumor or orbital cellulitis, or persistent headache, fever, or nausea and vomiting after antibiotic therapy should have additional evaluation for SIE. Children with hyperglycemia or diabetes may be at increased risk for SIE. The ESR and CRP levels are markedly elevated in children with SIE and may be useful screening tools. MRI with gadolinium is the preferred method to diagnose SIE. If MRI is unavailable, a contrast-enhanced head CT with axial and coronal planes should be obtained. Nonenhanced CT alone lacks sensitivity, and a normal study may be falsely reassuring.
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机译：背景。中源性颅内积脓（SIE）是鼻窦炎的罕见并发症，可导致毁灭性的神经系统后遗症。尽早识别临床发现至关重要，因此可以进行适当的管理。为了描述所报道的最大的儿科SIE病例系列之一的症状，体征以及实验室和影像学检查结果。描述性研究了2000年6月至2004年2月SIE收治的所有儿童的回顾性队列研究。通过计算机检索“儿童鼻窦炎”和“脑/硬脑膜下/硬膜外积液。”将SIE患儿的红细胞沉降率（ESR）和C反应蛋白（CRP）值与在与门诊病人相同的医疗系统中接受护理的一组单纯性鼻窦炎患儿进行了比较。除CRP和ESR值外，未对单纯性鼻窦炎组的病历进行任何临床或影像学检查。确定了十二名SIE儿童。 SIE患儿的中位年龄为11.5岁。症状通常在诊断前10天（中位数）出现，包括头痛（10），发烧（11），恶心/呕吐（7），精神状态改变（5）和癫痫发作（3）。体格检查结果包括异常的神经系统检查（9），Pott肿块状肿瘤（4）和眼眶蜂窝织炎（3）。使用Intermountain Health Care系统的计算机数据库，确定了142例单纯性鼻窦炎患儿作为门诊病人。 SIE患儿的CRP水平（中位数：10.05 mg / dL）和ESR（中位数：87 mm /小时）明显高于无并发鼻窦炎的儿童（CRP中位数：0.7 mg / dL; ESR中位数：6 mm /小时）。四个孩子患有高血糖症。四名儿童在报告时出现了腰椎穿刺，所有这些发现都是正常的。颅面成像包括计算机断层扫描（CT）和磁共振成像（MRI）。未进行CT增强的4例患者中未检测到SIE。仅轴向成像无法在1名蝶骨和筛窦性鼻窦炎儿童中显示SIE，需要冠状位图像以证明其存在和程度。最初的面部/眼眶影像学研究对2例复杂性鼻窦炎（眼眶蜂窝织炎和Pott肿块状肿瘤）的体征不足以检测SIE。使用对比增强的头部CT或MRI检查可对所有12名儿童进行SIE诊断。患有鼻窦炎并有任何神经系统发现，患有复杂性鼻窦炎的症状（如Pott肿块状肿瘤或眼眶蜂窝组织炎）或持续性头痛，发烧，恶心和呕吐的儿童，在接受抗生素治疗后应对SIE进行其他评估。高血糖或糖尿病患儿发生SIE的风险可能会增加。 SIE患儿的ESR和CRP水平明显升高，可能是有用的筛查工具。带有with的MRI是诊断SIE的首选方法。如果无法使用MRI，则应获得具有轴向和冠状平面的对比增强的头部CT。单独的非增强CT缺乏敏感性，正常的研究可能会错误地使人放心。
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