Acute frontal sinusitis can be a serious condition because of its potential life-threatening complications. These complications, including spread of infection to the frontal bone and intracranially, require prompt diagnosis and intervention to avoid morbidity and mortality 1).
Usually, the patient presents with headache that is either diffuse or localized to one side with scalp tenderness. Headache may be the only presenting symptom. The patient may have persistent fever that develops during or after treatment for sinus or middle ear infection. Purulent discharge from the ears or sinuses, periorbital swelling, and brawny edema of the scalp might accompany. Because the epidural abscess usually enlarges slowly, the following signs do not develop until the infection has reached the subdural space, resulting in subdural empyema, at which time the patient might present with neck stiffness, nausea, vomiting, lethargy, and hemiparesis. Seizures might very well be the first presenting symptom in some cases. Symptoms and signs of increased intracranial pressure (ICP) include nausea, vomiting, and papilledema. Rarely, when the epidural abscess develops near the petrous bone and involves the fifth and sixth cranial nerves, the patient may present with ipsilateral facial pain and weakness of the lateral rectus muscle (ie, the so-called Gradenigo syndrome). Many times, scalp cellulitis, sinusitis, or skull fracture may draw the attention of the physician to such an extent that the diagnosis of epidural abscess may be missed. One should consider the diagnosis of intracranial epidural abscess when a patient presents with unresolving frontal sinus symptoms. Also consider this diagnosis in patients with new neurologic symptoms after trauma or cranial surgery, even if months or years have elapsed since operation or trauma. Onset can be acute, especially in patients without any history of previous cranial neurosurgery. They often present with acute symptoms of encephalopathy and focal neurological deficits.
A case of intracranial epidural abscess, 20 years after allograftic cranioplasty was presented. The abscess was caused by bacterial implantation after a minor stab wound of the scalp over the cranioplastic plate. It seemed quite rare that the intarcranial abscess occurred 20 years after an allograftic cranioplasty 2).