Sinusitis diagnosis

Zinreich SJ, Kennedy DW, Malat J et al (1988) Fungal sinusitis diagnosis with CT and MR imaging. Radiology 169 439-444... 

Although many clinical studies have been performed evaluating antibiotics for ABRS, no randomized, double-blind, placebo-controlled studies have used pre- and posttreatment sinus aspirate cultures as an outcome measure. Despite this, antibiotics appear to resolve symptoms more quickly and reduce failure rates and complications compared with no treatment.35-37 Since diagnosis usually is based on clinical presentation and not sinus aspirate cultures, clinicians must attempt to differentiate ABRS from viral rhinosinusitis. Therefore, it is important to limit antibiotic use to cases where infection is unlikely to resolve without causing prolonged disease patients with mild to moderate symptoms that persist for 10 days or worsen over 5 to 7 days and patients with severe symptoms,31,34... 

Ioannidis JP, Lau J. Technical report Evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children—A systematic overview. Pediatrics 2001 108(3) e57. 

Suggested Alternatives for Differential Diagnosis Meningitis, basilar artery blood clots (thrombosis), cardioembolic stroke, cavernous sinus syndromes, cerebral venous blood clots (thrombosis), confusional states and acute memory disorders, epileptic and epileptiform encephalopathies, febrile seizures, haemophilus meningitis, intracranial hemorrhage, leptomeningeal carcinomatosis, subdural pus (empyema), or bruise (hematoma). 

Atrial fibrillation is commonly associated with heart failure, and the prevalence of atrial fibrillation is related to the severity of heart failure, with less than 5% affected with very mild heart failure to nearly 50% affected with advanced heart failure [66]. Heart failure and atrial fibrillation are both common cardiovascular disorders and share the same demographic risk factors, including age, history of hypertension, prior myocardial infarction, and valvular heart disease [67, 68]. Further, the incidence of heart failure increases dramatically after the diagnosis of atrial fibrillation [69]. Progression of LV dysfunction can clearly be associated with rapid ventricular rates [70-76]. Conversely, conversion to normal sinus rhythm or control of ventricular response in atrial fibrillation can improve LV function [71-74, 77]. Accordingly, rate control becomes very important in patients with heart failure and dilated cardiomyopathy, and likely even more so when ischemia from rapid rates complicate the patient s course. 

Patients with leukemia often suffer from infections of the upper respiratory tract before the diagnosis of their haematologic malignancy is made. Chemotherapy for malignancy causes toxic stomatitis and superinfection with yeasts may follow. In patients with diabetes mellitus, malignant otitis externa and fungal sinusitis (mucormycosis) can be life-threatening. 

Atropine can be used in the differential diagnosis of S-A node dysfunction. If sinus bradycardia is due to extracardiac causes, atropine can generally elicit a tachy-cardic response, whereas it cannot elicit tachycardia if the bradycardia results from intrinsic causes. Under certain conditions, atropine may be useful in the treatment of acute myocardial infarction. Bradycardia frequently occurs after acute myocardial infarction, especially in the first few hours, and this probably results from excessive vagal tone. The increased tone and bradycardia... 

A major type of headache that must be considered in differential diagnosis is that caused by underlying disease intracranial disturbances (e.g., vascular anomalies, infections, tumors, trauma) diseases involving the head and neck but not the brain (e.g., cervical osteoarthritis disorders of eye, ear, nose, sinuses, and throat cranial neuralgias) and systemic diseases (e.g., sudden and severe hypertension, hyperthyroidism). These headaches usually can be relieved by specific therapy for the underlying disorder (e.g., surgical correction of tumors, antibiotics for infections, antiarthritic drugs for osteoarthritis). 

CT venography of cerebral veins is a very reliable technique for the demonstration of intraluminal abnormalities of dural sinuses (Figs. 18.10a, 18.12a Ozsvath et al. 1997). In particular, multisection CT venography with subtraction of bone is a promising and competitive technique for the evaluation of veno-occlusive disorders of the cerebral veins and sinuses (Majoie et al. 2004). One disadvantage, however, is the radiation exposure. Conventional DSA is typically not needed unless endovascular treatment is necessary, since MRI, MRA and CT are usually sufficient to make a correct diagnosis. 

Vogel TJ, Bergman C, Villringer A, Einhaupl K, Lissner J, Felix R (1994) Dural sinus thrombosis value of venous MR angiography for diagnosis and follow-up. Am J Roentgenol 162 1191-1198... 

The authors discussed the difficulty of the differential diagnosis between lithium intoxication and other neurological disorders, such as strokes. What they did not discuss was the possibility that the presentation was caused by sinus node dysfunction, which has been reported as a complication of lithium treatment. 

Three patients developed bUateral venous sinus thromboses after receiving asparaginase the diagnosis and follow-up of this complication have been succinctly reviewed (9). In another patient receiving asparaginase, central nervous system thrombosis was associated with a transient acquired type II pattern of von WiUebrand s disease (10). 

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