背景:鼻-鼻窦炎和颅内出血是其各自的医学专业中普遍存在的疾病。虽然鼻窦炎主要是一种局限于鼻旁窦的炎性疾病,它可以,在极其罕见的情况下,导致颅内出血和潜在的致命后果。尽管这种罕见的关联非常严重,关于其病理生理机制的文献仍然很少,自然史,管理原则,和临床结果。
方法:我们在系统评价和荟萃分析指南的首选报告项目之后进行了系统的文献综述,并以一例由鼻-鼻窦炎引起的表皮血肿为例进行了说明。
结果:对文献的系统回顾确定了20例已发表的鼻窦炎引起的颅内出血,加上这里提出的案例,病例总数为21例。发现19例硬膜外血肿(EDH)和2例硬膜下血肿(SDH)。额叶区域(14/19,74%)是EDH最普遍的位置,对应于额窦相关的鼻窦炎(12/14,86%)。常见症状包括头痛(n=18,86%),发热和意识障碍(n=13,62%),和眶周肿胀/疼痛(n=8,38%)。干预措施包括血肿清除/引流,鼻窦手术,和抗生素疗法。发生1例死亡和3例残留的神经损伤。关于鼻窦炎颅内出血的机制存在多种假设。
结论:颅内出血并发症,主要是EDH和SDH,是鼻-鼻窦炎的罕见和潜在的致命后果。在临床实践中应该认识到这种可能性的潜在存在。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 (EDH) and 2 subdural hematomas(SDH) 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 three residual neurological impairments occurred. Multiple hypotheses exist regarding the mechanisms of intracranial hemorrhage in rhinosinusitis.
CONCLUSIONS: Intracranial hemorrhagic complications, primarily EDH and SDH, are rare and potentially fatal consequences of rhinosinusitis. It should be cognizant of the potential existence of such a possibility during clinical practice.