Cerebral stroke as a rare complication of sphenoiditis
, 1, 1, 1, 1, 2, 2
Abstract
Introduction: Ischaemic stroke is mainly associated with atherosclerosis or cardiac embolism, seldom
with inflammatory infiltration of cerebral arteries. The present study describes a case of sphenoiditis that
resulted in an ischaemic stroke.
Case report: A 72-year-old woman was admitted due to severe headache to the Otolaryngology Department
with a diagnosis of acute sphenoiditis. After intranasal sphenoidotomy she complained of diplopia and
occipital area headaches; meningeal signs were present. Lumbar puncture revealed increased cytosis in
the cerebrospinal fluid leading to a diagnosis of bacterial meningitis. Broad-spectrum antibiotic therapy
has been applied and the patient was transferred to the Neurology Department. Later, she became disoriented,
restless, aggressive, refused to take her medications and tried to leave the hospital. Babinski sign
was present on the right side, without significant paresis. Brain MRI showed inflammatory changes in the
meninges and brain tissue. Meningoencephalitis was diagnosed. Then, the patient developed aphasia
and right-sided hemiparesis. Control brain MRI additionally showed foci of restricted diffusion in the left
hemisphere and inflammatory changes with restriction of blood flow in the left middle cerebral artery.
Ischaemic stroke of the left hemisphere was diagnosed as a complication of encephalitis with inflammatory
infiltration of the left middle cerebral artery. Antiplatelet therapy was introduced (apart from the used so far
heparin) along with post-stroke rehabilitation. After a few weeks of treatment, MRI showed a regression of
both ischaemic and inflammatory changes. The patient’s neurological condition improved – withdrawal
of hemiparesis occurred, but disorientation persisted, and the patient required care. She was transferred
to the Rehabilitation Department.
Conclusions: Complications of the sinusitis are uncommon and usually affect the immunocompromised
patients. However, they should be also taken into consideration while examining immunocompetent
patients, because sinusitis can result not only in meningitis, encephalitis or brain abscesses but rarely
also in ischaemic stroke.
Keywords: ischemic strokemeningitissphenoiditis
References
- Krishnan RD, Kumarasekaran P, Raja RV. Isolated sphenoid sinusitis. Indian J Otolaryngol Head Neck Surg. 2019; 71(Suppl 3): 1762–1764.
- Charakorn N, Snidvongs K. Chronic sphenoid rhinosinusitis: management challenge. J Asthma Allergy. 2016; 9: 199–205.
- Gupta R, Shukla R, Mishra A, et al. Isolated acute sphenoid sinusitis presenting with hemicranial headache and ipsilateral abducens nerve palsy. BMJ Case Rep. 2015; 2015.
- Sadineni RT, Velicheti S, Kondragunta CS, et al. Multiple cerebrovascular complications due to sphenoid sinusitis. J Clin Diagn Res. 2016; 10(11): TD03–TD05.
- Leong WS, Mulla O. Lateral rectus muscle palsy secondary to sphenoid sinusitis. Ann R Coll Surg Engl. 2022; 104(8): e239–e243.
- N L. Ishak, S. T. Subha, and S. Abu Bakar, “Isolated sphenoid sinusitis: A big headache., ” Malays Fam Physician, vol. 14, no 1, pp 29–30. ; 2019.
- Young KS, Kiam JS, Metcalf K, et al. Sphenoid sinusitis: a rare cause of ischaemic stroke. BMJ Case Rep. 2021; 14(10).
- Tan H, Ong YK. Acute isolated sphenoid sinusitis. Ann Acad Med Singap. 2004; 33(5): 656–659.
- Steadman CD, Salmon AHJ, Tomson CRV. Isolated sphenoid sinusitis complicated by meningitis and multiple cerebral infarctions in a renal transplant recipient. Nephrol Dial Transplant. 2004; 19(1): 242–244.
- Lin HC, Cheng YF, Yang TH. Stroke and chronic rhinosinusitis: a look backward and forward. Pol Arch Intern Med. 2021; 131(4): 322–323.
- Fabre C, Atallah I, Wroblewski I, et al. Maxillary sinusitis complicated by stroke. Eur Ann Otorhinolaryngol Head Neck Dis. 2018; 135(6): 449–451.
- Papadopoulou AM, Marinou A. Rhinosinusitis and stroke: a systematic review. Cureus. 2023; 15(6): e40923.