Abducens Nerve Palsy and Optic Perineuritis Caused by Fungal Sphenoidal Sinusitis

PURPOSE: To report a case of abducens nerve palsy and optic perineuritis caused by fungal sphenoidal sinusitis. CASE SUMMARY: A 48-year-old male visited emergency department for retrobulbar pain, decreased vision, and horizontal diplopia for 3 days. He reported that previous medical history was non-specific, however, blood glucose level was 328 mg/dL (70–110). He had experienced severe headache for 7 days. The best corrected visual acuity was 20/20 at right eye and 20/25 at left eye. The pupil of left eye did not have relative afferent pupillary defect. Left mild proptosis was noted. The extraocular examination showed 30 prism diopters left esotropia at primary gaze and −4 abduction limitation of left eye. The left eye showed mild optic disc swelling and inferior field defect by field test. Brain magnetic resonance imaging showed enhancement of sphenoidal sinus, ethmoidal sinus, and around optic nerve at left eye. Three days after antibiotics treatment, the vision of left eye deteriorated to 20/40 and periorbital pain developed. The drainage and biopsy of sphenoidal sinus were performed. The histopathologic examination showed hyphae consistent with aspergillosis. The ocular symptoms were improved with anti-fungal treatment. Follow-up magnetic resonance imaging performed 1 month after treatment showed improvement of lesion at left orbit. Five months after surgery, the visual acuity of left eye was improved to 20/25. The patient showed orthotropia at primary gaze without limitation. CONCLUSIONS: The abducens nerve palsy and optic perineuritis can be caused by fungal sphenoidal sinusitis. The early diagnosis and appropriate treatment can lead to favorable outcome.

Intracavernous Sinus Arachnoid Cyst Confused with the Complication of Mycotic Sphenoidal Sinusitis / 대한이비인후과학회지

The arachnoid cyst is a rare disease that accounts for about 1% of the intracranial mass. The etiology of arachnoid cyst is due to either congenital compromise of arachnoidal development or acquired inflammatory reaction or trauma in the subarachnoid space. Computed tomography of arachnoid cyst demonstrates well-marginated low density lesions, whereas magnetic resonance image shows identical signal intensities of cerebrospinal fluid on T1 and T2 weighted image and low signal intensity on diffuse weight imaging without contrast-enhancement. The treatment of intracavernous sinus arachnoid cyst must be tailored to each patient according to the location of the lesion within cavernous sinus and the patient's symptoms. We experienced a case of arachnoid cyst of the cavernous sinus accompanying mycotic sphenoidal sinusitis. There are no previously reported cases of patients with an intracavernous sinus arachnoid cyst accompanying mycotic sphenoidal sinusitis.

A Case of Orbital Apex Syndrome Related to Sphenoid Fungal Sinusitis / 대한이비인후과학회지

Orbital apex syndrome (OAS) has been described previously as a syndrome involving damage to the oculomotor nerve, trochlear nerve, abducens nerve, and ophthalmic branch of the trigeminal nerve in association with optic nerve dysfunction. The conditions and symptoms of OAS are characterized by blindness, fixed dilated pupils, proptosis, ptosis of the eye and ophthalmoplegia. Infectious diseases involving the central nervous system, paranasal sinuses, and periorbital structures may lead to an OAS. We recently experienced a rare case of sphenoidal aspergillosis, which damaged the adjacent cavernous sinus structures and led to the definite symptom of OAS in a 75 year-old female. We present this rare case with a brief review of these disease's entities.