Superior branch palsy of the oculomotor nerve caused by rhinocerebral mucormycosis.

A 75-year-old woman presented with fever and right temporal, periorbital and facial pain for 7 days. Physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with mild exophthalmos. She also had hyperglycemia. CT scan of the paranasal sinuses showed acute sinusitis. Rhinoscopy demonstrated black necrotic tissue in the nasal septum. KOH preparation of tissue biopsy specimen revealed large, non septate hyphae with right angle branching, diagnostic of rhinocerebral mucormycosis. She was treated with amphotericin B, surgical debridement and insulin therapy. Surgical tissue specimen also confirmed mucormycosis. She improved after treatment, but 4 months later, ptosis and upward palsy still persisted.

Intracranial complications of chronic suppurative otitis media.

Twenty-nine patients with chronic suppurative otitis media with intracranial complications are reviewed. The complications occurred predominantly in young patients with a mean age of 17 years. The most common complication was brain abscess (n = 20). The others were meningitis (n = 3), subdural abscess (n = 3), perisinus abscess (n = 2) and otitic intracranial hypertension (n = 1). The common pathogens were Gram-negative bacilli, especially Proteus and anaerobic organisms, respectively. The mortality rate was 7%.