Review Question - QID 109459

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Sinusitis Complications cerebral abscess QID: 109459 (M2.ET.17.4828)

QID 109459 (Type "109459" in App Search)

A 25-year-old man with a history of schizophrenia stable on his current antipsychotic regimen presents with a seizure. His mother noted that her son complained of a headache, stuffy nose, facial pain, and feeling warm for the past ten days. The headache was exacerbated whenever he bent over. This morning, the mother brought him to the hospital after he fell from the top of the stairs and appeared to convulse his arms and legs. He takes quetiapine and a multivitamin. In the trauma bay, the patient appears to be breathing comfortably and follows the nurse's commands. His temperature is 100.9°F (38.3°C), blood pressure is 140/70 mmHg, pulse is 80/min, respirations are 15/min, and his oxygen saturation is 95% on room air. He complains of a headache over the top of his eyebrows. He has a few scrapes and bruises throughout his body. His left arm and leg are weaker than his right limbs. His cranial nerves are grossly intact bilaterally. Computed tomography of his head is shown in Figure A. Which of the following is the most likely cause of this patient's presentation?

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Budding yeast organisms with hyphae

17%

8/48

Streptococcus species

35%

17/48

Staphylococcus species

3/48

Bacteroides fragilis

0/48

Toxoplasma gondii cysts

42%

20/48

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This patient has acute rhinosinusitis complicated by an intracranial abscess. Streptococcus species are the most common cause of sinusitis-associated abscesses in the immunocompetent host.

Acute rhinosinusitis is a clinical diagnosis requiring at least two major symptoms, where at least one involves nasal obstruction or purulent nasal discharge. Other major symptoms include facial pain/fullness and hyposmia/anosmia. Headache, halitosis, dental pain, cough, and ear pain/fullness are considered minor symptoms. Complications can involve the orbit, local bones, and the brain. Intracranial abscesses form most probably due to reflux of bacteria into cranial veins and the venous plexus around the cavernous sinus. They are most commonly due to the streptococcus species, which can be anaerobic or microaerophilic.

Figure A shows a right sided ring-enhancing lesion on computed tomography of his head.

Incorrect Answers:
Answers 1 & 5: Immunocompromised hosts with brain abscesses have a high risk of having fungal or protozoal infections.

Answer 3: Staphylococcus species are more common in patients with penetrating brain trauma.

Answer 4: Gram-negative species are less common causes of brain abscesses.

Bullet Summary:
Intracranial abscesses are well-recognized complications of rhinosinusitis and occur most commonly due to streptococcal species.

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