Intracerebral abscess secondary to frontal mucocele with underlying fibrous dysplasia.

Intracranial meningitis and intracerebral abscesses secondary to frontal sinus diseases, such as sinusitis and mucoceles, are well known? Frontal sinus mucoceles are usually the result of an inflammatory obstruction of the ostium. (2) However, other causes of frontal sinus obstruction can be identified, such as a frontal sinus osteoma, a post-traumatic sinus lesion, and occasionally obstruction by a fibro-osseous lesion, such as a fibrous dysplasia. (2,3)

In the case illustrated here, an intracranial complication from a frontal sinus mucocele with cerebral abscess was identified in a 45-year-old man who had complained of headaches, obtundation, and fever. The obstruction of the frontal sinus proved to be a localized fibrous dysplasia. Fibrous dysplasia represents a benign idiopathic bone disorder in which cancellous bone is replaced by abnormal fibrous tissue. (3) A frontal sinus mucocele is a rare complication of craniofacial fibrous dysplasia, as was demonstrated in this case by computed tomography (CT) (figure 1) and magnetic resonance imaging (MRI) (figure 2).

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References

(1.) Harnsberger HR. Sinonasal imaging: Imaging issues in sinusitis. In: Harnsberger HR. Handbook of Head and Neck Imaging. 2nd ed. St. Louis: Mosby, 1995:339-95.

(2.) Som PM, Brandwein MS. Inflammatory diseases. In: Som PM, Curtin HD, eds. Head and Neck Imaging. 4th ed. St, Louis: Mosby, 2003:193-259.

(3.) Atasoy C, Ustuner E, Erden I, Akyar S. Frontal sinus mucocele: A rare complication of craniofacial fibrous dysplasia. Clin Imaging 2001;25:388-91.