Intracranial Complications Following Acute Rhinosinusitis in a Pediatric Patient Requiring Surgery: A Case Report

Intracranial complications secondary to acute sinusitis in pediatric patients are rare but potentially life-threatening. Initially, the symptoms are nonspecific, which can result in a delayed diagnosis. If a patient presents with persistent fever and severe headache, an intracranial complication should be suspected and promptly investigated using imaging techniques such as contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). Here, we describe a case in which both a frontal epidural abscess and an interhemispheric subdural empyema developed following acute rhinosinusitis. The patient was a seven-year-old girl experiencing a persistent headache and fever for 10 days. Despite treatment with intravenous antibiotics, the symptoms did not improve. Blood cultures revealed Streptococcus intermedius infection. CT and contrast-enhanced MRI revealed both a left frontal epidural abscess and a left interhemispheric subdural empyema. The patient underwent emergency endoscopic sinus surgery (ESS) and neurosurgical drainage, followed by six weeks of antibiotic treatment, which resulted in full recovery with no neurological sequelae. One of the roles of ESS is to identify causative organisms, which can help guide antibiotic therapy and neurosurgical drainage. This case highlights the importance of early recognition and prompt surgical intervention in patients with invasive sinusitis complicated by intracranial complications.