ABSTRACT
A 37-year-old man presented with fever, decreased vision in the left eye, a partial left cranial nerve III paresis, and a left cranial nerve VI paresis. Neuro-imaging showed an opacification of a left pneumatised anterior clinoid process. After failing a course of intravenous antibiotics, a craniotomy was performed with exenteration of the cavity and resolution of symptoms. Although rare, a pyocele of a pneumatised anterior clinoid process may cause ocular morbidity and require surgical intervention.
Subject(s)
Abducens Nerve Diseases/etiology , Anti-Bacterial Agents/administration & dosage , Craniotomy/methods , Mucocele , Oculomotor Nerve Diseases/etiology , Sphenoid Bone , Suppuration/physiopathology , Abducens Nerve Diseases/physiopathology , Adult , Humans , Magnetic Resonance Imaging/methods , Male , Mucocele/complications , Mucocele/diagnosis , Mucocele/physiopathology , Oculomotor Nerve Diseases/physiopathology , Sphenoid Bone/pathology , Sphenoid Bone/physiopathology , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
A 48-year-old woman with a history of chronic intranasal cocaine abuse presented with unilateral proptosis associated with severe visual loss from optic neuropathy in the right eye. Imaging showed extensive bone and soft tissue destruction in the paranasal region and an orbital mass. Initial biopsies suggested a low-grade neoplasm. The correct diagnosis was established only on repeat biopsy, which revealed marked pleomorphism and nonspecific chronic inflammation with irregular collagen bundles containing thick-walled blood vessels. This case emphasizes that intranasal cocaine abuse may clinically, radiographically, and histopathologically mimic a neoplasm or a necrotizing vasculitis.
Subject(s)
Cocaine-Related Disorders/complications , Optic Nerve Diseases/etiology , Orbital Diseases/etiology , Paranasal Sinus Diseases/etiology , Administration, Intranasal , Blindness/diagnosis , Blindness/etiology , Cellulitis/diagnosis , Cellulitis/etiology , Chronic Disease , Cocaine/adverse effects , Exophthalmos/diagnosis , Exophthalmos/etiology , Female , Fibrosis/pathology , Humans , Middle Aged , Nasal Cavity/pathology , Optic Nerve Diseases/diagnosis , Orbit/pathology , Orbital Diseases/diagnostic imaging , Paranasal Sinus Diseases/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The diagnosis and etiologies of sixth cranial nerve palsies are reviewed along with nonsurgical and surgical treatment approaches. Surgical options depend on the function of the paretic muscle, the field of greatest symptoms, and the likelihood of inducing diplopia in additional fields by a given procedure.
