A Rare Case of Occipital Subdural Abscess of Rhinogenic Origin: Case Report

Abstract

In the present day scenario complications arising from sinusitis are rare, since the introduction of antibiotics. However Sinusitis and its complications are still existing and masking of symptoms due to inadequate dosage and duration of antibiotics, which is life threatening and if neglected may result in high morbidity and mortality. This case has been presented for its rare presentation of parafalcine abscess of left occipital lobe of middle cranial fossa, which is secondary to frontal sinusitis. A 40 year old male patient was admitted in ICU with chief complaints of fever for 3 days, headache and neck stiffness for 2 days and altered sensorium for 1 day. Computed tomography showed both frontals, ethmoids and maxillary sinusitis on the left side. Patient was given conservative treatment and showed partial improvement of symptoms. On repeat CT brain (after 2 weeks) showed abscess parasagittally in left occipital lobe. Neurosurgeon aspirated abscess through parasagittal approach. Later the patient referred to the ENT department and ESS (endoscopic sinus surgery) DRAF II procedure done for clearance of frontal sinus to avoid recurrence of intracranial complications.

Keywords: DRAF II; Frontal sinusitis; Occipital lobe; Parasagittal abscess.

Fig. 1

Picture showing frontal bossing in the patient

Fig. 2

showing frontal sinusitis

Fig. 3

showing ethmoid and maxillary sinusitis on the left side

Fig. 4

showing parafalcine abscess in left occipital lobe of middle cranial fossa

Fig. 5

showing parafalcine abscess in left occipital lobe region of middle cranial fossa with mass effect (compression of brain)

Fig. 6

Inspissated debris seen in frontal recess

Fig. 7

Clearing of debris from frontal sinuses

Fig. 8

Frontal recess after clearing the debris

Fig. 9

Rains self retaining Silastic stent placed in frontal recess