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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Central skull base osteomyelitis is a rare entity that can demonstrate confounding radiologic, clinical, and laboratory data leading to a delay in diagnosis. The morbidity and mortality for skull base osteomyelitis are both high, thus a rapid diagnosis is required for appropriate treatment. In this case report, we discuss a 68-year-old male who presented with acute left facial nerve paralysis in the setting of chronic headache and left mucoid middle ear effusion. Radiologic evaluation revealed abnormal hypointense marrow of the central skull base on T1 weighted magnetic resonance imaging, preclival mass-like tissue, and short segment luminal narrowing of the left cervical ICA with mycotic aneurysm formation. Extensive workup via a multidisciplinary approach, including neurology, otolaryngology, neurosurgery and radiology led to a diagnosis of central skull base osteomyelitis. A familiarity of this disease process is important for the radiologist in order to facilitate appropriate patient referral and treatment. This case emphasizes the importance of considering this diagnosis in the setting of headache, cranial neuropathy, and abnormal skull base imaging with adjacent preclival soft tissue mass.
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PMID:Central skull base osteomyelitis manifesting with a preclival mass and internal carotid artery mycotic aneurysm. 3267 Apr 51

We present a case of C1/C2 osteomyelitis secondary to malignant otitis externa complicated by atlantoaxial subluxation. This case is unique because surgical fixation of the spine was delayed, and despite clearance of the infection with antibiotics, the patient developed cervical myelopathy and required instrumented spinal fusion surgery. He presented with 1 month of fever, headache and worsening neck stiffness. An MRI of his cervical spine showed C1/C2 osteomyelitis with atlantoaxial subluxation. He was initially treated non-operatively with prolonged intravenous antibiotics and external immobilisation of his cervical spine. However, the first course of antibiotics failed, and he represented with a progression of his infection to the contralateral ear. He declined surgical intervention and completed a second course of antibiotics. Unfortunately, he eventually progressed to cervical myelopathy and subsequently underwent posterior C1 decompression with occipital to C4 instrumentation. There was no biochemical or bacterial culture evidence of infection at the time of the surgery. This case highlights the potential challenges in the management of cervical osteomyelitis-optimal duration of antibiotics is not supported by strong evidence and the clinician will therefore have to decide each treatment in the context of the patient. Spinal instability may still remain an issue after adequate treatment of the infection.
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PMID:C1/C2 osteomyelitis secondary to malignant otitis externa complicated by atlantoaxial subluxation-a case report and review of the literature. 3279 61

Pott's puffy tumor (PPT) is a nonneoplastic complication of acute frontal sinusitis characterized by subperiosteal abscess (SPOA) formation and osteomyelitis. Although various clinical conditions are associated with frontal SPOA, cases associated with odontogenic sinusitis are rare. We report a recurrent case of frontal SPOA who had a previous history of craniotomy due to head trauma. The patient was presented with headache, facial swelling and diagnosed as frontal, ethmoid, and maxillary sinusitis with frontal SPOA, which is PPT. The patient was surgically managed by endoscopic sinus surgery and external drainage of the abscess. Although the symptoms had been relieved soon after the surgery, they were recurred after 1 week. By paranasal sinus computed tomography scans, it was suspected that severe carious teeth, which were missed before surgery, induced maxillary sinusitis which spread into the frontal sinus and subperiosteal areas inducing recurrence of disease. Our experience suggests that frontal SPOA may originate from odontogenic maxillary sinusitis caused by severe dental caries, which should be actively managed, especially in patients with the risk of spread of inflammation, such as those who have discontinuity in frontal bone.
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PMID:Odontogenic Sinusitis-Associated Pott's Puffy Tumor: A Case Report and Literature Review. 3292 Nov 54

Skull base osteomyelitis (SBO) secondary to endoscopic surgery for chronic sinusitis and post-operative sphenopalatine artery electrocautery has not been previously reported. This case report details an instance of Central SBO with an unusual microbiology profile and highlights the need to readily consider SBO should patients present with persistent headache and cranial nerve palsies following sinus surgery. Laryngoscope, 2020.
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PMID:Polymicrobial Skull Base Osteomyelitis Related to Chronic Sphenoiditis and Endoscopic Sinus Surgery. 3299 Mar 41

Fungal rhinosinusitis (FRS) is inflammation of the paranasal sinus mucosa due to fungal infections, which can be invasive or non-invasive. The occurrence of a sphenoid mucocele with a fungal ball is rare. We report a case of sphenoid sinus mucocele with a fungal ball caused by Scedosporium apiopermum in a 32-year-old female who presented to the Emergency Department with persistent headache not relieved on medications. The radiological images showed a mucocele with clival osteomyelitis. Urgent endoscopic examination and debridement was undertaken which demonstrated a mucocele with fungal ball. Microbiological examination confirmed it to be Scedosporium apiopermum.
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PMID:A Rare Case of Fungal Rhinosinusitis Caused by Scedosporium apiopermum. 3316 38


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