Simultaneous Orbital and Intracranial Abscesses

Simultaneous Orbital and Intracranial Abscesses in 17 Cases:

Purpose: To describe the demographics, clinical presentation, treatment, and outcomes of a rare cohort with simultaneous orbital and intracranial abscesses. Methods: A historical cohort study of 17 patients with simultaneous orbital and intracranial abscesses between 2010 and 2018 was performed. The demographics, location of abscesses, treatment, and outcomes of these patients were analyzed. Results: The mean age was 26.9 years (range 5–83 years). Fourteen patients (82%) were male. In this cohort, the most common orbital abscess location was the superior orbit, involved in 14 patients (82%). The most common site of intracranial abscess was the frontal lobe, involved in 16 patients (94%). Concurrent sinus disease was present in 16 patients (94%). Surgical evacuation was the standard of treatment, with 94% of patients undergoing at least one surgical procedure. Streptococcus species were the most common, isolated from 6 sinus cultures (43%), 3 orbitotomy cultures (21%), and 4 craniectomy cultures (36%). Staphylococcus species were also common. Most patients (94%) had stable or improved mental status and visual function at the conclusion of their treatment. Conclusions: Simultaneous orbital and intracranial abscesses are rare. Local invasion from the orbit into the intracranial space may occur from direct spread, thus superior orbital abscesses pose the greatest risk for intracranial spread. Additional factors such as infection with Streptococcus and Staphylococcus species as well as male sex appear to be risk factors for intracranial spread. For those who develop intracranial abscesses, young age and absence of seizures or altered mental status at presentation may be associated with favorable outcomes. Accepted for publication May 23, 2020. Suzanne W. van Landingham and Mark J. Lucarelli’s roles were supported by an unrestricted grant from Research to Prevent Blindness, Inc. New York, New York, to the Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison. Suzanne W. van Landingham’s role was supported by the Heed Ophthalmic Foundation. Other authors have no conflicts of interest or sources of funding. This report adhered to the ethical principles outlined in the Declaration of Helsinki as amended in 2013. This report was carried out with HIPAA Compliance. Address correspondence and reprint requests to Renelle Pointdujour-Lim, M.D., Department of Ophthalmology and Visual Science, Yale School of Medicine; Yale Smilow Cancer Center, 35 Park Street, New Haven, CT 06510. E-mail: renelle.lim@yale.edu © 2020 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.