Orbital Complications resulting from Pseudomonal Infection of a Pneumatized Anterior Clinoid Process: A Case Report
Bibliographic record
Abstract
Objective: To describe a rare cause of acute isolated sphenoid sinusitis in an adult, immunocompetent, female, complicated by meningitis due to a clival abscess and subsequent development of orbital apex syndrome, originating from an infected pneumatized anterior clinoid process (ACP) Methods: We present a case report of a 61-year-old, healthy, female, who presented with a one-week history of fever, upper respiratory tract infection symptoms, and severe headache. Initial computed tomography (CT) of the head revealed isolated sphenoid sinusitis with posterior wall dehiscence communicating with the prepontine subarachnoid space. She underwent an endoscopic transseptal repair of the clival defect with a nasoseptal flap, followed by a three-week intravenous antibiotic regimen. Apart from consistent headaches, her postoperative course was unremarkable. Four months later, she presented with orbital apex syndrome. Magnetic resonance imaging (MRI) revealed mucosal disease in a pneumatized ACP. She underwent a second surgical intervention including a left-sided sphenoidectomy, orbital and optic canal decompression. Results: Initial surgical management successfully addressed the intracranial infection. However, persistent headaches and delayed onset of orbital apex syndrome occurred despite unremarkable interim imaging and endoscopy. A gadolinium-enhanced MRI ultimately identified inflammation within the pneumatized ACP, when the patient presented with orbital apex syndrome. Intraoperative cultures during the second surgery grew Pseudomonas, for which she underwent prolonged intravenous antibiotic therapy. There has been marked improvement in her symptoms, with a remaining mild sixth cranial nerve palsy and postnasal drip at her most recent follow-up. Conclusion: Isolated sphenoid sinusitis, especially involving a pneumatized ACP, can present insidiously and lead to serious intracranial and orbital complications despite early intervention. High clinical suspicion and early use of MRI are essential in patients with persistent symptoms and subtle imaging findings. Multidisciplinary management and long-term follow-up are crucial for optimal outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".