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Pott's puffy tumour: Harbinger of intracranial sepsis

Authors:
Yogesh Bhatt at Royal Free London NHS Foundation Trust
Yogesh Bhatt
Antonio Belloso
Antonio Belloso
Antonio Belloso
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Abstract and Figures

A 60-year-old woman presented with a 4-week history of unilateral forehead swelling following a coryzal episode. She described frontomaxillary pain and nasal discharge. Examination confirmed a fluctuant non-tender swelling (figure 1A) and ipsilateral mucopurulent rhinorrhoea. Neuro-ophthalmic examinations were unremarkable. A contrast-enhanced CT scan revealed a right-sided pansinusitis (figure 1B), an external subperiosteal collection with an underlying small extradural collection (figure 1C) and an interposed rarefied frontal bone (figure 1D). She underwent endoscopic sinus drainage with external frontal sinus trephine. The intracranial collection was managed conservatively with intravenous antibiotics and serial CT scans. Figure 1 (A) Clinical photograph of unilateral forehead swelling. Coronal CT scans demonstrate (B) opacification of the right maxillary and ethmoid sinuses and nasofrontal duct. Axial CT images …
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19. Phillipson OT, Bird ED. Plasma growth hormone concentrations in Huntington’s
chorea. Clin Sci Mol Med 1976;50:551e4.
20. Grottoli S, Gasco V, Ragazzoni F, et al. Hormonal diagnosis of GH hypersecretory
states. J Endocrinol Invest 2003;26:27e35.
21. Botfield C, Ross RJ, Hinds CJ. The role of IGFs in catabolism. Baillieres Clin
Endocrinol Metab 1997;11:679e97.
22. Hawker FH, Stewart PM, Baxter RC, et al. Relationship of somatomedin-C/insulin-
like growth factor I levels to conventional nutritional indices in critically ill patients.
Crit Care Med 1987;15:732e6.
23. Politis M, Pavese N, Yen F Tai, et al. Hypothalamic involvement in
Huntington’s disease: an in vivo PET study. Brain
2008;131:2860e9.
Neurological picture
Pott’s puffy tumour: harbinger of
intracranial sepsis
A 60-year-old woman presented with a 4-week history of unilat-
eral forehead swelling following a coryzal episode. She described
frontomaxillary pain and nasal discharge. Examination confirmed
afluctuant non-tender swelling (figure 1A) and ipsilateral muco-
purulent rhinorrhoea. Neuro-ophthalmic examinations were
unremarkable. A contrast-enhanced CTscan revealed a right-sided
pansinusitis (figure 1B), an external subperiosteal collection with
an underlying small extradural collection (figure 1C) and an
interposed rarefied frontal bone (figure 1D). She underwent
endoscopic sinus drainage with external frontal sinus trephine.
The intracranial collection was managed conservatively with
intravenous antibiotics and serial CT scans.
COMMENT
Pott’s puffy tumour describes a subperiosteal abscess overlying
frontal bone osteomyelitis. First documented as a sign of intra-
cranial empyema following head injury (1768) and subsequently
as a complication of frontal sinusitis (1775),
1
fewer than 20
adult cases have been reported in the post-antibiotic era.
2
It has
Figure 1 (A) Clinical photograph of
unilateral forehead swelling. Coronal CT
scans demonstrate (B) opacification of
the right maxillary and ethmoid sinuses
and nasofrontal duct. Axial CT images
demonstrate (C) an extracranial
subperiosteal collection and underlying
extradural empyema with (D)
rarefaction of the interposed frontal
bone.
J Neurol Neurosurg Psychiatry May 2011 Vol 82 No 5 547
Research paper
group.bmj.com on June 30, 2012 - Published by jnnp.bmj.comDownloaded from
also occurred as a late complication of neurosurgery,
3
cocaine
abuse
4
and dental sepsis.
5
Both Pott’s puffy tumour and its associated complications are
facilitated by the system of valveless veins draining the frontal
sinus mucosa, which promote septic emboli to seed the adjacent
bone, dura and cerebral parenchyma. Extension may also occur
via natural foramina or direct bone erosion. Intracranial
complications have been reported to occur in as many as 85% of
cases
6
and include meningitis, epidural or subdural empyema,
frontal lobe abscess and cavernous sinus thrombosis in addition
to orbital infections.
7
While the typical presentation is that of forehead swelling
with headache and fever, patients are frequently systemically
well and often without a clear history of preceding sinusitis.
8
Diagnostic imaging involves a combination of contrast-
enhanced CT of the head and paranasal sinuses and MRI with
gadolinium enhancement to exclude intracranial complications.
9
Gallium-67 scintigraphy has been employed to aid delineation of
osteomyelitic bone.
10
Causative organisms reflect those seen in chronic rhinosi-
nusitis wherein protracted mucosal oedema obstructs sinus
ostia and fosters a polymicrobial microaerophilic and anaer-
obic growth.
11 12
Isolated species have included Streptococci,
Staphylococci,Haemophilus influenzae,Enterococci and Bacteroides
spp.
13
Treatment involves a combination of surgical and medical
therapy. Surgical goals are abscess drainage, debridement of
osteomyelitic sequestra and obtaining tissue for Gram stain and
culture. Simultaneous external or endoscopic drainage of the
involved paranasal sinus is advised
14
with a breach of the
posterior table of the frontal sinus best managed by its cranial-
isation.
15
While bicoronal scalp flaps may provide optimum
surgical access, some have achieved clearance through eyebrow
incisions
16
and occasionally through serial aspiration.
17
If
craniotomy is performed, care must be taken to avoid damage to
the adherent dura under the diseased calvarium as perforation
may seed infection into the subarachnoid space.
14
A review of contemporary cases supports the early empirical
administration of broad spectrum antibiotics with anaerobic and
methicillin-resistant Staphylococcus aureus cover and good CNS
penetration prior to culture-directed therapy.
18
An appropriate
combination is ceftriaxone, metronidazole and vancomycin, but
consultation with local microbiologists is advised.
19
The
minimum duration of therapy may be 6 weeks and it may be
continued depending upon clinical response.
2
Close clinical and
radiological follow-up is required to allow the early identification
and treatment of recrudescent disease.
Yogesh M Bhatt, Antonio Belloso
Department of Otorhinolaryngology Head and Neck Surgery, Royal Blackburn Hospital,
Blackburn, Lancashire, UK
Correspondence to Mr Yogesh M Bhatt, Specialist Registrar in Otolaryngology,
Head-Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery,
Royal Blackburn Hospital, Haslingden Road, Blackburn, Lancashire BB2 3HH, UK;
bhatt_ym@yahoo.co.uk
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Accepted 14 January 2011
Published Online First 9 February 2011
J Neurol Neurosurg Psychiatry 2011;82:547e548. doi:10.1136/jnnp.2010.239327
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J Neurosurg 1996;84:110e12.
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2008;19:1694e7.
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computed tomography findings. J Craniofac Surg 2008;19:1697e9.
18. Bannon PD, McCormack RF. Pott’s puffy tumor and epidural abscess arising
from pansinusitis. J Emerg Med Published Online First: 18 Nov 2008.
doi:10.1016/j.jemermed.2008.04.050.
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´nA,Brell M, Cardona E, et al. Pott’s puffy tumour: still not an eradicated
entity. Childs Nerv Syst 2001;17:359e62.
548 J Neurol Neurosurg Psychiatry May 2011 Vol 82 No 5
Neurological picture
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doi: 10.1136/jnnp.2010.239327
online February 9, 2011 2011 82: 547-548 originally publishedJ Neurol Neurosurg Psychiatry
Yogesh M Bhatt and Antonio Belloso
intracranial sepsis
Pott's puffy tumour: harbinger of
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... tumour may also occur as a late complication of neurosurgery, in connection with cocaine abuse or in the context of a dental infection. 4 It develops when sinusitis spreads to the frontal bone, causing osteomyelitis and extension of purulent material anteriorly or posteriorly. 5 Adolescents and young adults are believed to be more prone to infection because of a developmental peak in the vascularity of the diploic venous system. 1 The frontal sinus generally completes development in the preteen years, 3,5 and Pott puffy tumour therefore tends to be excluded from the differential diagnosis of forehead swelling in younger children; however, as in our case, this may lead to a delay in diagnosis and treatment. ...
... The causative organisms of Pott puffy tumour reflect those seen in acute bacterial rhinosinusitis. 4 The most commonly cultured organisms include Streptococcus, Staphylococcus, H. influenzae, Enterococcus and anaerobes such as Fusobacterium and Bacteroides. 2,4,7 Polymicrobial growth has also been reported. ...
... 4 The most commonly cultured organisms include Streptococcus, Staphylococcus, H. influenzae, Enterococcus and anaerobes such as Fusobacterium and Bacteroides. 2,4,7 Polymicrobial growth has also been reported. 4 Streptococcus anginosus, which was isolated in this case, has not been described in relation to the condition. ...
CASES Pott puffy tumour in a five-year-old girl
Article
  • Nov 2014
A previously healthy five-year-old girl presented to a tertiary care pediatric hospital with a one-month history of frontal headache and decreased appetite. The most recent eight days had been characterized by fever and progressive swelling of the forehead. Three weeks before the presentation, she had been treated with a 10-day course of oral amoxicillin–clavulanic acid for sinusitis. The parents reported no sick contacts or recent travel. On physical examination, the patient was febrile but fully alert and oriented. Vital signs were otherwise normal. Her forehead was diffusely edematous, and she had bilateral periorbital edema with no conjunctival injection or ocular discharge. There was no evidence of skin abrasion or injury. Her forehead was exquisitely tender to palpation, but the overlying skin was not warm or erythematous. The results of a neurologic examination were normal, with full and painless extraocular movements. An oropharyngeal examination showed normal-sized tonsils without erythema or exudates, and the tympanic membranes were unremarkable. Computed tomography (CT) of the facial bones, performed earlier at a community hospital, showed diffuse soft-tissue swelling of the forehead and preseptal orbital regions consistent with cellulitis. There was no underlying osteomyelitis, frontal sinusitis or postseptal cellulitis. Blood work showed mild leukocytosis (12.5 × 109 [normal 5–12 × 109] cells/L), with neutrophil count 8 × 109 (normal 1.5–8.5 × 109) cells/L, normocytic anemia (hemoglobin 97 [normal 110–140] g/L) and platelet count 504 × 109 (normal 150–400 × 109) cells/L. The peripheral blood film was unremarkable. C-reactive protein was elevated, at 133 (normal 0–8) mg/L. Albumin was 33 (normal 32 to 56) g/L, and there was no proteinuria. Blood samples were drawn for culture. Given the normal results on the neurologic examination and the extracranial focus of infection, lumbar puncture was not performed. We admitted the patient to the general pediatric service with a presumed diagnosis of periorbital cellulitis and treated her with ceftriaxone and clindamycin, administered intravenously. With this treatment, the periorbital and forehead swelling resolved, but fevers continued over the next 48 hours as two well-defined masses developed, one on the patient’s forehead and one over the crown of her head. Needle aspiration yielded purulent fluid from both masses. Repeat CT showed two subgaleal frontal abscesses with underlying osteomyelitis and intracranial extension into an epidural empyema, which had invaded the superior sagittal sinus (Figure 1). These features confirmed a diagnosis of Pott puffy tumour. The patient was taken directly to the operating room, where the neurosurgical team performed craniectomy and drainage of the subgaleal abscesses. Culture of material from the abscesses revealed the offending bacteria: Streptococcus anginosus. Culture of blood samples drawn at admission showed no growth after five days. The patient recovered fully and completed a 12-week course of intravenous ceftriaxone and metronidazole at home. Figure 1: Contrast-enhanced computed tomography of the head of a five-year-old girl with headache and fever showing two large subgaleal abscesses (thick arrows) with osteomyelitis of the frontal bone (circled) and intracranial extension of the infection into an ...
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... unzureichend behandelten Sinusitis auf [2,10], die sich dann über das Os frontale ausbreitet und zu einer Osteomyelitis mit extra-und intrakraniellen Abszedierungen führt [4]. Das Erregerspektrum ist analog einer "community-acquired" Sinusitis mit Erregern wie Streptococcus spp., Staphylococcus spp., Haemophilus influenzae, Klebsiella spp., Anaerobier und En-terokokken, wobei Staphylokokken den häufigsten Erreger darstellten [2,3]. Da viele dieser Erreger zur physiologischen Hautflora gehören, ist oftmals die klinische Relevanz bei einem Nachweis durch Abstriche und Gewebsproben schwierig einzuschätzen. ...
... Auftreten kann ein PPT in jedem Alter, wobei Jugendliche mit bereits entwickelter Stirnhöhle überdurchschnittlich häufig betroffen sind, was durch eine höhere Rate an Infektion der oberen Atemwege in diesem Alter begründet ist [9]. Die meisten Fälle von PPT betreffen gesunde Patienten, jedoch ist auch ein Auftreten nach Kokainabusus, dentalen Infektionen oder als Spätfolge von neurochirurgischen Interventionen beschrieben [3]. Die bei der Geburt noch nicht entwickelten Stirnhöhlen beginnen im Alter von ca. ...
Pott-Puffy-Tumor: die Notwendigkeit einer interdisziplinären Diagnostik und Behandlung
Article
Full-text available
  • Mar 2022
Zusammenfassung Der Pott-Puffy-Tumor (PPT) stellt als bakterielle Infektion des Sinus frontalis mit subperiostaler und intrakranieller Abszessbildung eine seltene Erkrankung in der Pädiatrie dar. Nachfolgend präsentieren wir vier Fälle eines PPT, die bei zwei Kindern (6 und 9 Jahre) und bei zwei jungen Erwachsenen (17 und 19 Jahre) auftraten. Alle Patienten wurden interdisziplinär von einem Team aus Neurochirurgie, Pädiatrie, HNO-Heilkunde, Neuroradiologie und Mikrobiologie betreut. Die Antibiotikabehandlung wurde in einem Fall mit einer endoskopischen Nasennebenhöhlenoperation (FESS) und in den anderen drei Fällen zusätzlich mit einem offenen transkraniellen Zugang zur Drainage der intrakraniellen Abszessbildung kombiniert. Da der PPT im Kindesalter mit dem Befund einer intrakraniellen Abszessbildung einhergehen kann, ist eine enge interdisziplinäre Zusammenarbeit für eine erfolgreiche Behandlung dieser seltenen Erkrankung erforderlich.
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... As a complication of the latter, it can lead to osteomyelitis by spreading through the frontal bone [4]. Most bacteria found in PPT correspond to community-acquired sinusitis such as Streptococcus spp., Staphylococcus spp., Haemophilus influenzae, Klebsiella spp., anaerobes and enterococci, with staphylococci being the most common agents [2,3]. Of note, since many of these bacteria are also commensals of the skin, it is frequently challenging to estimate their actual clinical relevance when these bacteria are detected in microbiological analyses of swabs or tissue samples. ...
... It predominantly occurs in adolescents with a developed frontal sinus due to a higher incidence of upper respiratory tract infections and an increased risk of acute bacterial sinusitis [9]. Most cases are previously healthy patients, and sometimes PPT can occur as a result of cocaine abuse, in the context of dental infection, or as a late complication after neurosurgical interventions [3]. ...
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... As a complication of the latter, it can lead to osteomyelitis by spreading through the frontal bone [4]. Most bacteria found in PPT correspond to community-acquired sinusitis such as Streptococcus spp., Staphylococcus spp., Haemophilus influenzae, Klebsiella spp., anaerobes and enterococci, with staphylococci being the most common agents [2,3]. Of note, since many of these bacteria are also commensals of the skin, it is frequently challenging to estimate their actual clinical relevance when these bacteria are detected in microbiological analyses of swabs or tissue samples. ...
... It predominantly occurs in adolescents with a developed frontal sinus due to a higher incidence of upper respiratory tract infections and an increased risk of acute bacterial sinusitis [9]. Most cases are previously healthy patients, and sometimes PPT can occur as a result of cocaine abuse, in the context of dental infection, or as a late complication after neurosurgical interventions [3]. ...
Pott’s puffy tumor: a need for interdisciplinary diagnosis and treatmentPott’s-Puffy-Tumor: die Notwendigkeit einer interdisziplinären Diagnostik und Behandlung
Article
Full-text available
  • Jan 2022
Pott’s puffy tumor (PPT) is an infection of the frontal sinus with subperiosteal and intracranial abscess formation and one of the rare entities in pediatrics. We present a series of four cases of PPT that occurred in two children (6 and 9 years) and in two young adults (17 and 19 years). All patients were treated by an interdisciplinary team of pediatric, neurosurgical, ENT, radiological, and neuroradiological specialists. Antibiotic treatment was combined with single endoscopic surgery in one case and combined endoscopic sinus surgery with an open transcranial approach to drain intracranial abscess formation in three cases. It is important to be aware that PPT occurs in children with the finding of intracranial abscess formation. Therefore, a close interdisciplinary cooperation for successful treatment is needed in this rare disease.
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A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades
Article
Full-text available
  • Mar 2023
  • BSRCCS
The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients’ ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment.
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Utilização de Múltiplos Alvos no Tratamento da Agressividade: Relato de caso
Article
Full-text available
  • Aug 2021
Background: Aggressive behavior refers to multiple factors that cause harm to another individual who does not wish to be harmed. It can occur as self-aggressive or hetero-aggressive behavior and present a number of causes. Case presentation: Previously healthy patient presented with aggressive behavior after traumatic brain injury. Surgical procedure involving multiple targets was performed for the treatment of aggressiveness. Discussion: Several anatomical structures are involved in the genesis of aggressiveness. Therefore, different surgical procedures have already been proposed and performed in an attempt to improve the aggressive behavior. Conclusion: A single surgical procedure using multiple targets, considered feasible, safe, and effective, can reduce family stress as well as the costs of hospitalization due to a number of surgeries. In the reported case, anterior capsulotomy, subcaudate tractotomy, and nucleus accumbens ablation were performed in the same procedure. The patient evolved without complications and the surgical procedure resulted in satisfactory therapeutic response.
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Pott's Puffy Tumor Due to Haemophilus injiuenzae: Case Report and Review
Article
Full-text available
  • Jan 1997
Osteomyelitis of the frontal bone may be associated with a purulent collection under the periosteum, causing swelling and edema over the forehead, a condition known as Pott's puffy tumor. We describe an 83-year-old man with a Pott's puffy tumor due to Haemophilus injluenzae that was successfully treated with surgery and antibiotics. A review of 22 cases of Pott's puffy tumor shows that this condition usually occurs in children, is spread from frontal or ethmoid sinusitis, and is usually due to streptococci, staphylococci, or anaerobes. Suppurative complications such as epidural, subdural, and intracerebral abscesses are common. Only seven cases of Pott's puffy tumor in adults have been reported, and only one of these cases was caused by H. injluenzae. Surgical drainage and antibiotic therapy remain standard therapy for this condition.
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Pott's Puffy Tumor
Article
  • Dec 2008
  • J CRANIOFAC SURG
A subperiostal abscess of the frontal bone as a complication of osteomyelitis, appearing as a puffy, indolent tumor of the forehead, was first described by Pott. This less-common complication of is known as Pott's Puffy tumor. The complications of Pott's Puffy tumor are preseptal and orbital cellulites by downward spread to the orbit and intracranial infection by posterior extension. We present a case of Pott's Puffy tumor complicated by intracranial infection imaged by means of multidetector computed tomography.
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Pott's Puffy Tumor
Article
  • Dec 2008
  • J CRANIOFAC SURG
Pott's Puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma predominantly in the adolescent age group. Pott's Puffy tumor can be associated with cortical vein thrombosis, epidural abscess, subdural empyema, and brain abscess. The cause of vein thrombosis is explained by venous derange of the frontal sinus, which occurs through diplopic veins, which communicate with the dural venous plexus; septic thrombi can potentially evolve from foci within the frontal sinus and propagate through this venous system. An apparently healthy 7-year-old girl presented to the emergency service of otolaryngology with complaints of swelling of forehead and periorbital zone, headache, chills, fever, and rhinorrhea. The patient described in this case report had 2 important complications of paranasal sinus disease: the relatively common complication of postseptal cellulites and the less common complication of Pott's Puffy tumor.
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Pott's Puffy Tumor and Epidural Abscess Arising from Pansinusitis
Article
  • Dec 2008
  • J EMERG MED
Sinusitis is a common disorder that can result in rare but serious complications including periorbital or orbital cellulitis, intracranial abscess or meningitis, subperiosteal scalp abscess ("Pott's puffy tumor"), osteomyelitis, and cavernous sinus thrombosis. We report a case of a 41-year-old man who presented to our Emergency Department with pansinusitis. He did not obtain recommended follow-up treatment after discharge and 26 days later returned with a persistence of sinusitis, Pott's puffy tumor, and an intracranial abscess caused by Streptococcus intermedius. The patient required multiple otolaryngological and neurosurgical interventions and was treated with long-term antibiotic therapy. Pott's puffy tumor is a complicated infection that requires intravenous antibiotic and surgical treatment. Diagnosis is made by contrast-enhanced computed tomography scan. Early treatment significantly contributes to favorable outcome and decreases the risk of further complications such as epidural abscess.
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Percivall Pott: an 18th century neurosurgeon
Article
  • Mar 1992
  • J NEUROSURG
This paper examines neurosurgery in the 18th century and suggests that the origins of the specialty can be recognized at the time when surgeons began to use the neurological status of the patient as a guide for surgical intervention. Percivall Pott (1714-1788) was one of the leading surgeons in London in the 18th century. He is remembered through eponyms of Pott's puffy tumor, Pott's fracture, and Pott's disease. A review of his writings and those of his contemporaries indicates that these surgeons were aware of the importance of changes in level of consciousness after head injury. The recognition and significance of the lucid interval was described and understood as a neurosurgical sign in the 18th century. Because of Pott's pre-eminence in the surgery of his time through his writings and lectures, he should be considered one of the founders of neurosurgery as a separate surgical discipline.
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Pott's Puffy Tumor: A Complication of Intranasal Cocaine Abuse
Article
  • Jul 1991
  • Rev Infect Dis
The increasing intranasal abuse of cocaine has been associated with numerous medical problems. Among the most common complications are chronic sinusitis and septal perforation, although myocardial infarction and death also have been reported. We describe the development of Pott's puffy tumor in a patient who chronically abused cocaine. Pott's puffy tumor, a subperiosteal abscess of the frontal bone associated with frontal osteomyelitis, is a rare complication of frontal sinusitis. This case report underscores the dangers of cocaine abuse and describes yet another potentially serious sequela.
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Radiological evaluation of Pott puffy tumor
Article
  • Apr 1986
The Pott puffy tumor represents frontal osteomyelitis with subperiosteal (pericranial) abscess, secondary to frontal sinusitis. Pott puffy tumor is one of several potential complications of infection of a frontal sinus. Computed tomography (CT) and radionuclide bone imaging have proved to be invaluable tools in the diagnosis of frontal sinusitis, osteomyelitis, and intracranial infection. This article details the radionuclide bone imaging and findings on CT in three children with Pott puffy tumor, as well as the clinical features and pathophysicological mechanisms.
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Sinogenic intracranial complications
Article
  • Nov 1995
Two hundred and nineteen patients, with intracranial complications of sinusitis, are presented. Sinusitis is still a life-threatening condition and if neglected, or mismanaged, can lead to intracranial complications that result in a high mortality and morbidity. Twenty-two patients had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema. The diagnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, chemistry and culture. The most frequent presenting signs were fever (68 per cent) and headache (54 per cent). The most common localizing neurological sign was hemiparesis (35.5 per cent). Orbital inflammation was present in 41.5 per cent of patients. Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, performed within 12 hours of admission. In patients with meningitis, the surgery entailed surgery of the sinus disease only. In patients with subdural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approach, immediately after drainage of the intracranial collection of pus, was carried out. There were 35 deaths (16 per cent). The highest mortality rate was recorded in patients with meningitis (45 per cent) followed by brain abscess (19 per cent) and subdural empyema (11 per cent). Despite advances in medicine, i.e. antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial complications has remained significant. This can only be eliminated through education. This paper emphasizes to younger generations of otolaryngologists and primary care physicians that sinusitis is a serious disease and there is no place for delay or complacency when managing such patients.
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Pott's puffy tumor: the forgotten entity. Case report
Article
  • Feb 1996
  • J NEUROSURG
Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with underlying frontal osteomyelitis. The introduction of antibiotic medications has diminished the incidence of complications of frontal sinusitis. As a result, Pott's puffy tumor has become a rarity. In this communication a case of Pott's puffy tumor secondary to antecedent frontal sinusitis in an otherwise healthy adult man is described.
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