A case of multiple cranial nerve palsy due to sphenoid sinusitis complicated by cerebral aneurysm.
A case of sphenoid sinusitis and internal carotid aneurysm presenting with multiple cranial nerve palsy is reported. A 46-year-old man with high fever and neck rigidity developed progressive visual loss and ophthalmoplegia on both sides, and ptosis, mydriasis and facial numbness on the right side. CT scan and MRI revealed abnormal shadow of the sphenoid sinus and the cavernous sinus. Sphenoidectomy and antibiotic therapy improved left visual acuity, but the right visual disturbance remained. Cerebral angiography performed 20 days after the operation, showed an aneurysm of the cavernous portion of the right internal carotid artery. This aneurysm could be called "bacterial aneurysm" due to sphenoid sinusitis and cavernous sinusitis. However, there is another possibility that the enlargement of an idiopathic and asymptomatic intracavernous aneurysm due to rapid and severe parasinusitis induced bilateral cavernous sinus syndrome with the right side dominance. After endovascular coil placement, his right visual disturbance partially recovered.
Suzuki
Nobuhiro
N
Department of Otolaryngology, Tokyo Medical University, Shinjyuku-ku, Nishishinjyuku, 6-7-1, Tokyo 160-0023, Japan. nobu-suzuki@msf.biglobe.ne.jp
Suzuki
Mamoru
M
Araki
Susumu
S
Sato
Harushiro
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002343:Carotid Artery, Internal / Q000473:pathology*; D020806:Central Nervous System Bacterial Infections / Q000150:complications; D002533:Cerebral Angiography; D003389:Cranial Nerve Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology; D015524:Sphenoid Sinusitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology; D014792:Visual Acuity / Q000502:physiology
D000900:Anti-Bacterial Agents