Résumé
Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.
Sujets)
Humains , Femelle , Sujet âgé de 80 ans ou plus , Artérite à cellules géantes/imagerie diagnostique , Artère basilaire/imagerie diagnostique , Artère vertébrale/imagerie diagnostique , Atteintes du nerf moteur oculaire commun/imagerie diagnostique , Encéphalopathie ischémique/imagerie diagnostique , Nerf oculomoteur/imagerie diagnostique , Artères temporales/imagerie diagnostique , Artérite à cellules géantes/étiologie , Artérite à cellules géantes/anatomopathologie , Artère basilaire/anatomopathologie , Artère vertébrale/anatomopathologie , Imagerie par résonance magnétique/méthodes , Atteintes du nerf moteur oculaire commun/étiologie , Atteintes du nerf moteur oculaire commun/anatomopathologie , Encéphalopathie ischémique/étiologie , Encéphalopathie ischémique/anatomopathologie , Échographie-doppler/méthodes , Nerf oculomoteur/anatomopathologieRésumé
A 63-year-old woman presented with an extremely rare oculomotor schwannoma not associated with neurofibromatosis, manifesting as a transient diplopia and ptosis. Magnetic resonance images showed a well-enhanced mass extending from the cavernous sinus to the intraorbital region. Surgical exposure confirmed the tumor originating from the oculomotor nerve in the cavernous sinus. The intraorbital cystic part of the tumor was partially resected to preserve the oculomotor function. This is the first case of oculomotor schwannoma in the cavernous sinus with intraorbital component.