Intracranial Epidural Abscess in a 9-Year-Old Boy With Precocious Punerty and Use of Continuous Positive Airway Pressure

Intracranial Epidural Abscess in a 9-Year-Old Boy With Precocious Puberty and Use of Continuous Positive Airway Pressure.

• Wendy Edlund
• Neil Patel
• David DeLone
• Suresh Kotagal

抄録

鼻副鼻腔炎の頭蓋内進展は小児ではまれである．持続的気道陽圧（CPAP）治療中に鼻副鼻腔炎に続発した頭蓋内硬膜外膿瘍を発症した，中枢性早産性思春期と閉塞性睡眠時無呼吸低呼吸症候群を有する9歳の免疫不全の男児を報告する．カルテと画像検査のレトロスペクティブレビューを行った。MEDLINEおよびCochraneデータベースを検索し、CPAP治療を受けている患者や思春期早発症の患者で硬膜外膿瘍が発生したとの報告を得た。前頭副鼻腔炎の頭蓋内進展は、前頭副鼻腔の活発な成長とその豊富な血液供給のためか、思春期に多くみられる。コントロールされた研究では、CPAP上の成人の鼻副鼻腔炎の増加は示されていない；発表された研究では、CPAPの使用における鼻副鼻腔炎の頭蓋内伸展を評価していない。CPAP使用後に原因不明の激しい頭痛や発熱を伴う患者は、副鼻腔炎の頭蓋内進展を除外するために神経画像検査（磁気共鳴画像検査[MRI]/造影CT）が必要になることがあります。

Intracranial extension of rhinosinusitis is rare in children. We report a 9-year-old immunocompetent boy with central precocious puberty and obstructive sleep apnea-hypopnea syndrome who developed an intracranial epidural abscess secondary to rhinosinusitis while on continuous positive airway pressure (CPAP) treatment. A retrospective review of the medical record and imaging studies was performed. MEDLINE and Cochrane databases were searched for reports of epidural abscess developing in patients receiving CPAP treatment or in patients with precocious puberty. Intracranial extension of frontal rhinosinusitis is more common during puberty probably because of the active growth of the frontal sinuses and their rich blood supply. Controlled studies show no increase with rhinosinusitis in adults on CPAP; no published studies assess intracranial extension of rhinosinusitis in CPAP use. Patients with unexplained, severe headache and fever following CPAP use may require neuroimaging (magnetic resonance imaging [MRI] / contrast computed tomography) to rule out intracranial extension of sinusitis.