MR features of pachymeningitis presenting with sixth-nerve palsy secondary to sphenoid sinusitis.
(17/20)
Pachymeningitis manifested by localized enhancing dural thickening adjacent to the clivus on MR images of two patients with sphenoid sinusitis and sixth-nerve palsy is presented. This is an unusual complication of sphenoid sinusitis. Prompt diagnosis and therapy may avoid significant intracranial complications. (+info)
Risk factors for meningitis after transsphenoidal surgery.
(18/20)
To evaluate possible risk factors for meningitis, we retrospectively reviewed 228 transsphenoidal operations (in which a standard regimen of amoxicillin prophylaxis was used) for sellar pathology. The incidence of meningitis was 3.1% (seven of 228 cases). Cultures of preoperative specimens from the anterior nasal vestibule in three of seven patients yielded Staphylococcus aureus, but none of these patients developed S. aureus meningitis. Two of three patients with significant preoperative paranasal sinus abnormalities developed meningitis compared with only five of 225 patients without significant paranasal sinus abnormalities (P < .005). Three of 22 patients with intraoperative cerebrospinal fluid (CSF) leakage developed meningitis compared with four of 206 patients without intraoperative CSF leakage (P < .05). Six of seven patients with postoperative CSF rhinorrhea and only one of 221 patients without postoperative CSF rhinorrhea developed meningitis (P < .00001). In conclusion, postoperative CSF leakage is an important risk factor for meningitis after transsphenoidal surgery. Cultures of preoperative specimens from the anterior nasal vestibule did not have any predictive value in our study. (+info)
Infection due to Paecilomyces lilacinus: a challenging clinical identification.
(19/20)
We describe a case of noninvasive sinusitis caused by Paecilomyces lilacinus in a patient with diabetes mellitus. Cure was achieved by endoscopic drainage and aspiration of the fungal mass. We discuss the difficulty in and clinical importance of distinguishing Paecilomyces from Aspergillus. (+info)
Neuroimaging appearance of pituitary abscess complicated with close inflammatory lesions--case report.
(20/20)
A 13-year-old girl with a pituitary abscess complained of continuous headache and bitemporal hemianopsia after a common cold. However, she had no inflammatory reactions on admission. Computed tomography showed a low-density sellar mass lesion extending to the suprasellar cistern with a peripheral low-density area, and ring enhancement of the capsule with a particularly thick region. Magnetic resonance imaging showed the mass lesion as a low- and high-intensity area on the T1- and T2-weighted images, respectively. The iso-intense rim of the lesion and the left frontal mass lesion adjacent to the capsule were enhanced by gadolinium-diethylenetriaminepenta-acetic acid. Magnetic resonance imaging also indicated only mild sphenoidal sinusitis which may be representative of the inflammatory process. Careful assessments of neuroimaging findings and preceding trivial inflammatory signs are necessary for the correct diagnosis of a pituitary abscess. (+info)