Bilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia. Case report.
The authors report the successful treatment of a 42-year-old man who suffered from recurrent painful ophthalmoplegia caused by bilateral cavernous sinus (CS) actinomycosis. A presumptive diagnosis of Tolosa-Hunt syndrome was made when he presented with left painful ophthalmoplegia. Recurrent ophthalmoplegia on the opposite side when steroid medications were tapered led to repeated imaging and a pterional craniotomy and biopsy sampling of the CS. These tests demonstrated acute inflammation and sulfur granules, which responded clinically and radiologically to parenterally administered penicillin therapy. Actinomycosis may present as a painful ophthalmoplegia with involvement of one or both CSs. Repeated imaging and possibly surgical exploration may be necessary to make a definitive diagnosis.
Ohta
Seiji
S
Department of Neurosurgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Nishizawa
Shigeru
S
Namba
Hiroki
H
Sugimura
Haruhiko
H
D000196:Actinomycosis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D001706:Biopsy; D002426:Cavernous Sinus / Q000473:pathology; D003937:Diagnosis, Differential; D004292:Dominance, Cerebral / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D020333:Tolosa-Hunt Syndrome / Q000175:diagnosis / Q000473:pathology