Paramenigeal infection is a life-threatening condition and may be more serious than acute bacterial meningitis. Depending on which sinuses are involved, there may be a variety of clinical presentations. Frontal sinusitis and skull osteomyelitis may cause Pott's Puffy Tumor, resulting in a unilateral or occasionally bilateral swelling ofthe orbital region due to a subperiosteal abscess. Occasionally theinfection extends into the epidural region. A dural tear from previous headtrauma, may result in a subdural empyema, resulting in rapidly progressing neurologic deterioration, meningeal signs, focal neurologic deficits, andseizures.
Treatment is dependent on the responsible organism.
The organism usually comes from the adjacent sinus, and is often penicillin resistant S. aureus or a gram negative rod. An abscess in the subdural or intracranial space should be surgically treated, to identify the organism, and institute appropriate antibiotic therapy, and to reduce the mass effect. Nonbacterial Infections Nonbacterial organisms may involve the sinuses, causing acute neurologic deterioration. In diabetics and leukemics, molds, such as Rhizopus and Mucormycosis , may result in a fulminant meningoencephalitis, progressive neurologic deterioration, cranial nerve palsies, seizures, and infarction. Therapy is for fungal brain infection IV amphotericin B, and mortality is very high.