From the Guidelines
Yes, sinusitis can cause altered mental status, particularly in severe cases or when complications develop, as evidenced by the potential for intracranial complications such as meningitis, brain abscess, or venous thrombosis, as noted in the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1.
Key Points to Consider
- Sinusitis can lead to serious complications that affect the brain and central nervous system, resulting in altered mental status, which is a medical emergency requiring immediate attention.
- The risk of altered mental status due to sinusitis is higher in immunocompromised patients, those with untreated or inadequately treated sinusitis, or when certain bacteria are involved.
- Symptoms of altered mental status in the context of sinusitis can include confusion, disorientation, personality changes, or decreased consciousness.
- The connection between sinusitis and altered mental status is due to the anatomical proximity of the sinuses to the brain, allowing infection to potentially spread through direct extension or via blood vessels.
Diagnostic and Treatment Considerations
- If someone with sinusitis develops altered mental status, they should be treated with intravenous antibiotics, such as vancomycin plus ceftriaxone or cefepime, and possibly surgical drainage, as suggested by the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1.
- Imaging studies, such as contrast-enhanced CT or MRI, may be necessary to confirm intracranial or intraorbital suppurative complications, as recommended in the clinical practice guideline for adult sinusitis 1.
- It is essential to consult with specialists, including otolaryngologists, ophthalmologists, and infectious disease experts, to guide the management of complicated sinusitis cases, as noted in the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1.
From the Research
Sinusitis and Altered Mental Status
- Sinusitis can lead to intracranial complications, which may cause altered mental status, as reported in a study published in 2009 2.
- The study found that diffuse headache or two-step evolution headache and altered mental status were strongly correlated with meningitis and brain abscess.
- Another study published in 1998 also found that altered mental status was a common symptom of intracranial complications of sinusitis in children 3.
- A review of complications of sinusitis published in 2016 noted that intracranial infections, including abscesses of the epidural and subdural spaces, can occur as a result of acute bacterial rhinosinusitis (ABRS) and may cause altered mental status 4.
- Additionally, a study published in 2017 found that resolution of sinusitis was associated with improvement of psychiatric symptoms, including obsessive-compulsive symptoms, in some patients 5.
- A more recent study published in 2022 highlighted the importance of early detection and multidisciplinary approach in managing intracranial complications of sinusitis, which can include altered mental status 6.