Orbital and intracranial complications after acute rhinosinusitis

Background/objectives: Nowadays, intracranial abscess is a rare complication of acute rhinosinusitis. The consequent orbital and intracranial complications of acute rhinosinusitis are rare but must be mutually excluded in complicated rhinosinusitis even when proper surgical and medical treatment tend to efficiently heal the orbital complication. Methods: We report a case of a patient who primarily revealed symptoms of orbitocellulitis as a complication of odontogenous rhinosinusitis. Proper diagnostic and therapeutical measures were undertaken to manage the disease immediately after stationary admission. We strongly rely on a literature review and recommendations on diagnosis and treatment of this possibly lethal complication in the discussion. Results: Two weeks after an inconspicuous healing period, hemiparesis due to formation of an intracranial abscess developed. An emergency situation revealed the unusual character of the clinical situation. In a literature review concerning intracranial complication after acute rhinosinusitis, we demonstrate the complexity of this complication. We indicate the predisposing factors, diagnostic measures and treatment strategy. Conclusion: The possible role of underlying mechanisms of intracranial abscess formation is discussed. The correct indication of imaging methods and accurate evaluation of diminutive symptoms are essential. We recommend performing a complementary CT of the brain or MRI, even when a previous CT scan of the orbit/paranasal sinuses reveals no cerebral pathology, to avoid or minimize the number of Attire patients with consecutive orbital and intracranial complications of acute rhinosinusitis.