By Amanda MacMillan
March 16, 2018

A Michigan community is in mourning after the death of 13-year-old Marquel Brumley, and the circumstances behind the eight-grader’s death are certainly alarming: After being diagnosed at an urgent-care facility with a viral infection that would “run its course,” Brumley’s symptoms—including severe headaches—got worse.

Brumley reportedly went to the emergency room several times but was sent home each time with over-the-counter pain medication. It was only when his face became swollen and lost muscle movement that doctors performed an MRI, which revealed a sinus infection that had “penetrated through the bone into the blood vessels in the brain,” Brumley’s aunt told People. Doctors performed surgery to control the infection, but blood clots had already formed, cutting off oxygen to his brain. Brumley died days later.

Sinus infections are extremely common, and, while uncomfortable, usually not deadly. So we wanted to know what, exactly, can cause them to become dangerous—and what warning signs people should look out for. To find out, we spoke with Richard Lebowitz, MD, professor in the department of otolaryngology at NYU Langone Health. Dr. Lebowitz wasn’t involved in Brumley’s case but has been diagnosing and treating sinus problems for many years.

“This is a very sad story, and it’s also exceedingly rare,” Dr. Lebowitz says. “I think I’ve seen something like this once in 25 years of practice.” Fortunately, he says, it’s not something most people should be worried about if they’re diagnosed with a routine common cold or viral sinus infection.

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Viral sinus infections—also known as sinusitis—usually clear up on their own, says Dr. Lebowitz. But occasionally, infections can occur in a region called the sphenoid sinus, located behind the eyes near the optic nerve. Because of their location, these infections tend to cause earaches, neck pain, or pain behind the eyes or in the temples.

Infections in the sphenoid sinuses also tend to be more dangerous than other types of sinus infections, because of their proximity to the cavernous sinus—a blood-filled area at the base of the brain. News reports have not stated if this is the type of infection Brumley had, but Dr. Lebowitz says this could be one potential explanation.

“When you get an infection and there’s inflammation here, sometimes you can get clotting of the small veins in this area,” says Dr. Lebowitz. Clots can block the veins carrying blood from the brain back to the heart, causing pressure to build up in the brain itself.

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Treatment for this condition can include IV antibiotics, steroid medications, anti-clotting drugs, and surgery to relieve pressure on the brain. “But by the time it gets to this point, it’s a very serious condition, and it usually doesn’t end well,” says Dr. Lebowitz.

The good news, says Dr. Lebowitz, is that sphenoid infections are rare; studies have estimated they make up less than 3% all sinus infections. And even when they do occur, blood clots don’t typically follow.

That being said, Dr. Lebowitz says people should take notice if they—or their children—are diagnosed with a simple viral infection that seems to be getting worse and not better. “With anything that’s not behaving the way you would expect, you have to start thinking about other potential causes and complications,” he says.

That’s especially true if you or your child’s symptoms include fever, pain in the face and neck, vision problems, or redness or swelling around the eyes. (Eye-related complications of sinus infections can occur even without blood clots, says Dr. Lebowitz, and it’s important that those are diagnosed and treated early as well.)

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Severe headaches should be a warning sign, too, especially in a person with no history of migraines. It’s normal for sinus infections to cause some pain and congestion, but patients should call their doctor if their headaches get worse rather than better after an initial diagnosis.

“Everyone’s got a different threshold for going to the emergency room,” says Dr. Lebowitz. “But when a young, otherwise healthy person has a headache that’s bad enough to send them to the hospital, it’s important to do an X-ray or a brain scan and look for the potential causes that could be dangerous.”