Intracranial Hemorrhagic Complications of Rhinosinusitis: A Systematic Literature Review and Case Illustration.

Abstract

Rhinosinusitis and intracranial hemorrhage are prevalent conditions within their respective medical specialties. While rhinosinusitis is predominantly an inflammatory disease confined to the paranasal sinuses, it can, in exceedingly rare circumstances, lead to intracranial hemorrhage with potentially fatal outcomes. Despite the gravity of this rare association, the literature remains sparse regarding its pathophysiological mechanisms, natural history, management principles, and clinical outcomes. We present a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a case illustration of epitural hematoma arising from rhinosinusitis. A systematic review of the literature identified 20 published cases of intracranial hemorrhage induced by rhinosinusitis; plus the case presented herein, the total number of cases is 21. Nineteen epidural hematomas (EDHs) and 2 subdural hematomas were identified. The frontal region (14/19, 74%) was the most prevalent location for EDH, corresponding to sinusitis related to the frontal sinus (12/14, 86%). Common symptoms included headache (n = 18, 86%), fever and impaired consciousness (n = 13, 62%), and periorbital swelling/pain (n = 8, 38%). Interventions included hematoma removal/drainage, rhinosinus surgery, and antibiotic therapies. One fatality and 3 residual neurological impairments occurred. Multiple hypotheses exist regarding the mechanisms of intracranial hemorrhage in rhinosinusitis. Intracranial hemorrhagic complications, primarily EDH and subdural hematomas, are rare and potentially fatal consequences of rhinosinusitis. It should be cognizant of the potential existence of such a possibility during clinical practice.