XXXIII. A Case of Brain Abscess Dependent upon Empyema of the Frontal Sinus

Berens T. P. : The Laryngoscope, Vol. XXVL, 1916, p. 1085, ff. W., age thirty years. Radical operation for pansinusitis on January 16. This did not stop discharge and pain. One year later a second operation discovered granulations in the roof of the sinus. These were hiding a perforation through which a probe extended 2 1/8 inches. Rubber drainage inserted. Cure.

Butzenzeiger : Münchener Medizinische Wochenschrift, 1911. Case of cured frontal sinus abscess. No details.

Elschnig A. : Prager Medizinische Wochenschrift, Vol. XXXIX, 1914, p. 37. Case 1.—Boy, age twelve years. Phlegmon of left upper eyelid. Incision. Apathy. Paresis of right side of body. Roof of orbit removed. Incision of frontal lobe abscess. Cure. Case 2.—Male, age forty-five years. Chronic frontal sinusitis. Killian operation. Aphasia. Orbit contained granulations. Removed orbital roof and incised abscess in frontal lobe. Exitus. Purulent meningitis.

Freudenthal W. : The Laryngoscope, Vol. XX, 1910, pp. 60–75. Case 1.—J. S., age twenty-five years. Headache and discharge. Acute empyema of right frontal sinus. Edema of right eye. Radical operation on frontal sinus and incision into bulging dura both evacuated pus. Drainage through nose. Patient in stuporous condition. Second opening of dura emitted more pus. Death in a few hours, due, it seems, to delay of operation. Case 2.—L. K., age twenty-five years. Swelling over right eye two weeks after attack of influenza. Frontal sinus opened after Kuhnt, evacuating pus. Part of bone removed. Semistupor and bulging of dura led to second operation five days later. Incision of dura evacuated about 100 cubic centimeters of pus. Cure in six weeks. Case 3.—L. S., age nineteen years. Semistuporous condition and edema of left eye and forehead. Removal of small portion of anterior wall of frontal sinus evacuated pus. Stupor. Motor aphasia. Later, paralysis of right upper and lower extremities. Second operation made wide opening into frontal sinus and opened ethmoid cells, evacuating pus. Probe discovered that the sphenoid sinus and adjoining brain tissue formed one large abscess cavity. Death in a few hours. Case 4.—Tailor. age thirty-eight years. Frontal sinus and ethmoid cells opened, both showing some pus. Continued pain led to reopening of frontal sinus two months later, disclosing no pus. Dura incised with negative result. Exitus in coma. No autopsy was permitted, but the assumption that there was one or more pus cavities within the brain seems safe.

Gerber : “Die Complicationen der Stirnhöhlenentzündungen,” Berlin, 1909.

Heigel : Prager Medizinische Wochenschrift, 1914. Patient, age thirty-three years. Case of acute sinusitis. Fifth day, radical operation. Eight days later, incision of dura. No pus. Exitus one month later. Organisms of diphtheria and influenza.

Mackenzie G. W. : Proceedings of the Royal Society, 1914. A manifest fistula in frontal sinus. Abscess in orbit. Opened and drained. Fistula did not close. Six weeks later operation; X-ray “normal frontal sinus.” Probe entered large abscess in frontal lobe through opening in posterior wall. Drained. Recovery. Disease present of frontal and maxillary sinus.

McCoy J. : Annals of Otology, Rhinology and Laryngology, Vol. 19, 1910, pp. 287–294. Case 1.—J. L., age one and one-half years. Upper eyelids swollen after attack of pneumonia. Incisions evacuated pus. Operation on frontal and ethmoid regions, discovering necrosis. Incisions into forehead disclosed osteomyelitis. Paralysis. Frontal lobe entered through dura, emitting pus and ceerbrospinal fluid. Death in a few hours. Case 2.—H. E., age ten years. Incision of swollen upper eyelids. Frontal sinus exposed through Killian incision. Incision of swelling on left forehead discovered epidural abscess. Area of necrotic bone removed. Two months later ethmoid labyrinth removed. Convulsions. Large abscess found in the brain but not drained well, and five days later a second abscess appeared. Both are now well drained. Recovery.

Onodi : Semon's Internationales Centralblatt, Vol. XXVI, 1910, p. 423. (Transactions of the International Medical Congress in Budapest, 1909.) Three cases of brain abscess. No details.

Piffl O. : Prager Medizinische Wochenschrift, Vol. XXXIX, 1914, p. 39. Male, age thirty-six years. Chronic frontal sinusitis left. Exophthalmos. Intranasal treatment. Cerebrospinal fluid cloudy. Diplopia. Vomiting. Ptosis. Killian operation. Optic neuritis. Five weeks later, pain and rise of temperature. Vomiting. Oribtal roof removed. Frontal lobe incised. No pus. Exitus. Postmortem: Left frontal lobe adherent to orbital roof. Abscess in frontal lobe.

Zemann W. : Zeitschrift für Laryngologie, Rhinologie und ihre Grenzgebiege, Vol. VI, 1913–14, p. 545. G. B. age thirty-seven years. Chronic frontal sinusitis. Fistula through left eyebrow. Killian operation on both sides. Necrosis of posterior wall of right frontal sinus. Facial paralysis on left. Paralysis of left hypoglossal nerve. Left hemiplegia. Clonic spasms of upper extremities. Stupor. Cheyne-Stokes breathing. Exitus. Postmortem: Leptomeningitis. Frontal lobe adherent to posterior surface of frontal sinus. Cortical abscess in frontal lobe. From here there is a fistula leading to two deeper abscesses in frontal lobe.

Elsberg : Annals of Surgery, Vol. 66, 1917, p. 508. Abscess of the frontal lobe following orbital cellulitis.