A Pott's puffy tumour is a subperiosteal abscess and osteomyelitis of the frontal bone secondary to frontal sinusitis. Intracranial complications are seen in approximately 40 per cent of cases and are potentially life-threatening; such complications have not previously been reported in pregnancy.

A 21-year-old woman at 35 weeks' gestation presented with a history of frontal headaches and swelling, periorbital oedema, pain and chemosis. Imaging confirmed Pott's puffy tumour with right-sided epidural empyema and periorbital cellulitis. A multidisciplinary team was involved in the patient's management. Intravenous antibiotics were commenced and initial percutaneous drainage through the frontal sinus skin was performed, followed by endoscopic sinus drainage. A caesarean section was performed 3 days later. Complete resolution of the sinus and intracranial collections was noted on imaging performed six weeks later.

This case highlights the challenges of managing rare intracranial complications of sinusitis in pregnancy, and the importance of multidisciplinary care.

To review the management, causative organisms, morbidity and mortality of intracranial abscesses secondary to sinus and ear disease.

Retrospective, case note review of suppurative intracranial complications of ear and sinus disease in patients admitted to a regional neurosurgical centre between 1980 and 2004. These data were compared with published material from the same region from 1950–1979.

There was a marked reduction in the mortality rate and the number of intracranial abscesses secondary to chronic ear disease, comparing the two time periods. However, there was little change in the percentage of sinus-related abscesses treated and in their symptoms, signs, abscess location and long term morbidity. Microbiology results showed that streptococcal species predominated as causative organisms, with a high percentage of anaerobic bacteria in otogenic abscesses.

Despite improved outcomes, a high index of suspicion for intracranial complications of ear or sinus disease should be maintained in the presence of appropriate signs and symptoms.