Primary melanoma of the sphenoid sinus presenting with a third cranial nerve palsy.
An 83-year-old woman presented with right trigeminal paresthesias, upper lid ptosis, and diplopia and was found to have a right third cranial nerve palsy. MRI disclosed a right sphenocavernous mass with speckled high signal on pre-contrast T1 and correspondingly low signal on T2. Endoscopic sphenoidotomy revealed malignant melanoma. The patient underwent radiation therapy with complete and protracted resolution of the palsy. An extensive evaluation for a primary source was negative. The combination of high T1 signal and low T2 signal in a mass should suggest melanin. An exceedingly rare condition, this is the first English report of its presentation with a third cranial nerve palsy.
Lynch
Shannon C
SC
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Lee
Andrew G
AG
Graham
Scott M
SM
Kirby
Patricia A
PA
D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000175:diagnosis; D004172:Diplopia / Q000175:diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008545:Melanoma / Q000473:pathology*; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis*; D010255:Paranasal Sinus Neoplasms / Q000473:pathology*; D013101:Sphenoid Sinus / Q000473:pathology*; D014057:Tomography, X-Ray Computed