SHM Converge Scientific Abstract ePoster Gallery-Beyond the Stroke Code: Sinusitis Masquerading as a Neurological Emergency

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This case report describes a 56-year-old woman with granulomatosis with polyangiitis (GPA) and recurrent MRSA sinusitis who presented with acute right facial droop, facial numbness, and tongue deviation, prompting a stroke alert. Initial evaluation with CT and MRI showed no ischemia or hemorrhage, but did reveal pansinusitis. Because stroke imaging was negative, clinicians considered pseudo-stroke causes, especially mononeuritis multiplex from a GPA flare and bacterial sinusitis with cranial nerve involvement.<br /><br />The patient had elevated inflammatory markers and positive respiratory cultures for MRSA and ESBL E. coli, so she was treated with vancomycin and meropenem. Her immunosuppressive medications were temporarily held. Over five days, her neurologic symptoms completely resolved with antibiotics alone, and ENT endoscopy later showed no purulence or evidence of acute sinusitis. She was discharged after a seven-day IV antibiotic course and later resumed her GPA treatment without recurrence of pseudo-stroke symptoms.<br /><br />The report emphasizes that stroke-like presentations are not always vascular and that pseudo-stroke should be considered when imaging is unrevealing. In patients with GPA, important non-stroke causes include mononeuritis multiplex, cerebral vasculitis, and sinusitis. Mononeuritis multiplex often occurs with active GPA and may require immunosuppression, whereas sinusitis-related cranial nerve dysfunction may improve with antibiotics. In this case, symptom resolution without immunosuppression supported bacterial sinusitis as the most likely cause.<br /><br />Key lesson: after ruling out true stroke, clinicians should broaden the differential for neurologic deficits, especially in patients with autoimmune disease and sinus symptoms. Prompt recognition and targeted treatment can lead to good outcomes.

Asset Subtitle

Camryn Keller

Meta Tag

Author List Bruno Álvarez Concejo, Camryn Keller

Category Clinical Vignettes

Concept Stroke Mimic

Concept Acute Stroke

Concept Granulomatosis with Polyangiitis

Concept Differential Diagnosis

Concept Mononeuritis Multiplex

Distinguished Non-Finalist

Presenter Organization Louisiana State University Health Sciences Center- Shreveport

Presenting Author Camryn Keller

Track Adult

Keywords

granulomatosis with polyangiitis

MRSA sinusitis

stroke alert

pseudo-stroke

mononeuritis multiplex

cranial nerve involvement

pansinusitis

bacterial sinusitis

vancomycin

meropenem

Stroke Mimic

Acute Stroke

Granulomatosis with Polyangiitis

Differential Diagnosis

Mononeuritis Multiplex