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Show Abstract: A 90- year- old woman developed an acute left years earlier, hypothyroidism, and osteoporosis. Medica-third cranial nerve palsy. Brain imaging revealed a left tions included levothyroxine, lisinopril, nicardipine, triam-sphenoid sinus mucocele. Endoscopic marsupialization of terene, hydrochlorothiazide, risedronate, celecoxib, and the mucocele led to complete resolution of the third cranial aspirin. nerve palsy. Visual acuity was 20/ 20 OU, and confrontation visual . . . . _ , , , , -„„_ „ „„„ „„.. fields were normal. Pupils were equal at 4 mm OU with ( J Neuro- Ophthalmol 2005; 25: 293- 294) , . . , F , . 1, ^ .„ , ,. normal reactivity and no relative atterent pupillary detect. Ductions were full OD. The OS would not adduct beyond A90- year- old woman developed binocular diplopia fol- the midline; supraduction was diminished but infraduction lowed by complete ptosis OS. There were no symptoms and abduction were intact. Complete upper lid ptosis was of giant cell arteritis. She had had hypertension for ten years present OS. Exophthalmometric, biomicroscopic, and oph-and hypercholesterolemia for five years but no history of thalmoscopic examinations were normal, as were assess-diabetes. She had had a left carotid endarterectomy several ments of trigeminal and facial nerve function. The diagnosis was left pupil- sparing third cranial Departments of Ophthalmology, Neurology, and Neurosurgery nerve palsy. Complete blood COUnt, electrolytes, and glucose ( MSV) and Radiology ( GHR), University of Alabama at Birmingham, were normal. Cholesterol Was 140 mg/ dL, triglycerides Birmingham, Alabama. 170 mg/ dL, and an erythrocyte sedimentation rate was Supported in part by an unrestricted grant from the Research to ^ o mm/ h Prevent , , , Blindness, Inc.,, New, Y. o, r. k ,, Ne, w „ Y, o. rk., . , „„ TTAD „ , A b, rain and, orb, i. t MRI scan sh, owed, a l, a rge non- Address correspondence to Michael S. Vaphiades, DO, UAB, Depart- => ment of Ophthalmology, Suite 601, 700 South 18th street, Birmingham, enhancing mass in the left sphenoid sinus compressing the AL 35233; E- mail: vaph@ uab. edu cavernous sinus ( Fig. 1), including the region where the third cranial nerve was passing through. Computed to- has also been reported to cause ophthalmoparesis by exten-mography ( CT) showed that the mass was expanding the sion into the orbit from above ( 9,10). sinus wall and causing remodeling of bone consistent with Treatment consists of marsupialization of the muco-the effects of a chronic mucocele. Brain magnetic resonance cele, usually resulting in rapid regression of the ophthalmic angiography ( MRA) was normal. manifestations ( 2). However, optic neuropathy seldom The patient underwent endoscopic marsupialization recovers ( 7). of the mucocele. One month after surgery, the third cranial nerve palsy had completely resolved. Mucoceles are cyst- like lesions lined with respiratory REFERENCES epithelium; retention of mucoid secretions leads to thinning L ^ H> c i h a n B Celenk c Sphenoid sinus mucocele causing third and erosion of the sinus bony walls ( 1,2). More than half of nerve paralysis: CT and MR findings. Dentomaxillofac Radiol 2004; these lesions are located in the frontal sinuses, with most of 33: 342- 4. . . . . . . . . . . . . . . . 2. Friedmann G, Harrison S. Mucocoele of the sphenoidal sinus as the remainder being m the ethmoid sinuses. Sphenoid sinus a cause of recurrent oculomotor nerve palsy. j Neurol Neurosurg mucoceles are relatively rare, representing 1% of all paranasal Psychiatry 1970; 33: 172- 9. Sinus mucoceles ( 3,4). They usually Start unilaterally, but 3- Prepageran N, Subramaniam KN, Krishnan GG, et al. Ocular . . . _ . . . . . . . presentation of sphenoid mucocele. Orbit 2004; 23: 45- 7. by the time of presentation, the entire sphenoid sinus com- 4 Sethi DS> Lau DP chan c Sphenoid sinus mucocoele presenting plex may be opacified and expanded with thinning of its with isolated oculomotor nerve palsy. J Laryngol Otol 1997; 111: bony walls. The sinus expands anteriorly at the level of the 471- 3. . . . . . . . . . . . , 5. Ashwin PT, Mahmood S, Pollock WS. Sphenoid sinus mucocoele anterior clinoid process where the third cranial nerve bears mimicking aneurysmal oculomotor nerve palsy Eye 2001; 15: 108- 10. closest relationship to the sinus ( 5). Compression of the 6. Chen HI Kao LY, Lui CC. Mucocele of the sphenoid sinus with the cavernous sinus may cause exophthalmos and periocular aPex orbitae syndrome. Surg Neurol i986; 25: ioi^. . . . . , . _ . 7. Johnson LN, Hepler RS, Yee RD, et al. Sphenoid sinus mucocele pain ( 2,3,6- 8). Cranial neuropathies are a teature in as ( anterior clinoid variant) mimicking diabetic ophthalmoplegia and many as 50% of Cases ( 4). The third cranial nerve is the retrobulbar neuritis. Am J Ophthalmol 1986; 102: 111- 15. most frequently involved ( 5). Sparing of pupil function 8- P e r s o n GH, Patterson AK, Deeb ME, et al. Sphenoethmoidal . . . . . . , , „ , r /-,\ • mucocele: radiographic diagnosis. AJRAm J Roentgenol 1976; 127: mimics a vasculopathic process in 46.6% of cases ( 7), as in 595_ 9 Our patient. Other patients present with periocular pain and 9. Lin CI Kao CH, Kang BH, et al. Frontal sinus mucocele presenting a third Cranial nerve palsy with pupilloparesis that mimics as oculomotor nerve palsy. Otolaryngol Head Neck Surg 2002; 126: aneurysmal compression ( 5). In some Cases, the third Cranial 10 Ehrenpreis SI Biedlingmaier JF Isolated third- nerve palsy associated nerve palsy may wax and wane ( 2). Frontal sinus mucocele with frontal sinus mucocele. JNeuroophthalmol 1995; 15: 105- 8. |
