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Clinical Note |

Prepontine Epidural Abscess A Rare Complication of Bacterial Rhinosinusitis

Alejandro Vazquez, MD; Tekchand Ramchand, BA; Arjuna B. Kuperan, MD; James K. Liu, MD; Jean Anderson Eloy, MD
Arch Otolaryngol Head Neck Surg. 2012;138(5):512-514. doi:10.1001/archoto.2012.438.
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Prepontine epidural abscesses are extremely rare disease entities. To our knowledge, only 2 previous cases have been reported in the literature, neither of which was attributed to rhinosinusitis. Although the precise incidence of intracranial complications of rhinosinusitis is unknown, it is estimated that 3% to 4% of patients who are hospitalized for sinusitis develop central nervous system involvement. Suppurative intracranial complications of acute bacterial rhinosinusitis (ABRS) include subdural empyema, epidural and intraparenchymal abscesses, meningitis, thrombosis of the dural sinuses, and cavernous sinus thrombosis. We report an unusual case of a prepontine epidural abscess that developed from ethmoid and sphenoid bacterial sinusitis and resulted in right sixth nerve palsy. Institutional review board approval was obtained from the University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark.

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Figure 1. Preoperative computed tomographic (A) and magnetic resonance (B-D) images. A, A preoperative axial computed tomogram shows opacification of the sphenoid sinuses and the right ethmoid sinus, with a bony defect in the posterior wall of the right sphenoid sinus and a right paramedian clival collection (arrow). Preoperative T1-weighted gadolinium-enhanced sagittal (B) and axial (C) and T2-weighted (D) images of the brain reveal a right paramedian prepontine collection (arrows) immediately anterior to the basilar artery.

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Figure 2. Preoperative (A and B), intraoperative (C), and postoperative (D) magnetic resonance images. Preoperative axial (A) diffusion-weighted image shows a hyperintense right paramedian prepontine collection (arrow) with corresponding hypointensity on apparent diffusion coefficient (B) imaging consistent with restricted diffusion suggestive of an abscess. C, An intraoperative image shows purulent discharge from the right clival defect (arrow). D, A T1-weighted gadolinium-enhanced sagittal image of the brain reveals complete resolution of the prepontine collection.




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