Cerebral stroke as a rare complication of sphenoiditis

Introduction: Ischaemic stroke is mainly associated with atherosclerosis or cardiac embolism, seldom with inflammatory infiltration of cerebral arteries. The present study describes a case of sphenoiditis that resulted in an ischaemic stroke. Case report: A 72-year-old woman was admitted due to severe headache to the Otolaryngology Department with a diagnosis of acute sphenoiditis. After intranasal sphenoidotomy she complained of diplopia and occipital area headaches; meningeal signs were present. Lumbar puncture revealed increased cytosis in the cerebrospinal fluid leading to a diagnosis of bacterial meningitis. Broad-spectrum antibiotic therapy has been applied and the patient was transferred to the Neurology Department. Later, she became disoriented, restless, aggressive, refused to take her medications and tried to leave the hospital. Babinski sign was present on the right side, without significant paresis. Brain MRI showed inflammatory changes in the meninges and brain tissue. Meningoencephalitis was diagnosed. Then, the patient developed aphasia and right-sided hemiparesis. Control brain MRI additionally showed foci of restricted diffusion in the left hemisphere and inflammatory changes with restriction of blood flow in the left middle cerebral artery. Ischaemic stroke of the left hemisphere was diagnosed as a complication of encephalitis with inflammatory infiltration of the left middle cerebral artery. Antiplatelet therapy was introduced (apart from the used so far heparin) along with post-stroke rehabilitation. After a few weeks of treatment, MRI showed a regression of both ischaemic and inflammatory changes. The patient’s neurological condition improved – withdrawal of hemiparesis occurred, but disorientation persisted, and the patient required care. She was transferred to the Rehabilitation Department. Conclusions: Complications of the sinusitis are uncommon and usually affect the immunocompromised patients. However, they should be also taken into consideration while examining immunocompetent patients, because sinusitis can result not only in meningitis, encephalitis or brain abscesses but rarely also in ischaemic stroke.