A 78-year-old woman presented with an acute onset of urinary incontinence and paraparesis. She also had hypertension and a 1-year history of memory impairment and personality changes, before which she had been able to live alone and take care of herself. Physical examination revealed a 4 × 7-cm soft pulsatile mass bulging centrally on her forehead. The neurologic examination demonstrated a lack of orientation to time and place and paraparesis, with the right leg being weaker than the left. Magnetic resonance imaging revealed the presence of a bilateral extra-axial mass in the frontal region that measured up to 7 cm in anteroposterior diameter and 9 cm in transverse diameter (Figure 1). The mass appeared to extend through the anterior floor of the skull into the superior nasal septum. The patient underwent a bifrontal craniotomy and was found to have a 4 × 4-cm defect in the frontal bone. Immediately under the bone, there was a collection of foul-smelling green pus representing an infected mucocele. A sample of the pus was sent for aerobic, anaerobic, and fungal cultures, which yielded β-lactamase–negative Haemophilus influenzae. Vancomycin hydrochloride (1 g) was intravenously administered after surgery. The patient was treated with a 6-week course of ceftriaxone sodium and metronidazole, with significant improvement of her behavioral disturbances and paraparesis, but unfortunately she continues to be incontinent.
Ada S, Yalamanchili M, Kambhampati G. Frontal Sinus Mucopyocele. Arch Intern Med. 2002;162(21):2487–2488. doi:10.1001/archinte.162.21.2487
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