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

ABSTRACT

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.