[Neurological manifestations of isolated sphenoiditis]

To review the neurological manifestations of isolated sphenoiditis.

The symptoms, signs, imaging data, diagnoses and outcomes of 14 cases with sphenoiditis hospitalized in Peking Union Hospital June 1995-January 2001 were analyzed retrospectively.

The chief complaints of this group included headache (12 cases), visual loss and/or diplopia (7 cases), blood in nasal discharge (3 cases), purulent nasal discharge (2 cases), exophthalmoptosis (1 case), fixation of eyeball (1 case), and pharyngodynia (1 case). Six patients presented deficits of the second and/or third, fourth, and sixth cranial nerves; one patient had hemiplegia and aphasia; no more presentation of nervous system was found in all patients. Only five patients showed signs of posterior sinusitis in rhinologic examination. CT and/or MRI revealed isolated sphenoiditis (11 cases) and sphenoiditis with posterior ethmoiditis (3 cases). The complications of this group were intracranial infection involving frontal, temporal, and parietal lobes and brainstem (1 case), aneurysm of cavernous carotid artery (1 case), nasal cerebrospinal fluid leakage (1 case), optic neuritis (5 eyes), abducent paralysis (2 cases), orbital cellulitis (1 case) and orbital apex syndrome (1 case). All of the patients underwent endoscopic sphenoid surgery. 13 patients were free of headache after surgery. One patient died because of hernia of brain.

Headache can be the first or unique symptom of isolated sphenoiditis. Isolated sphenoiditis should be considered in diagnosis and differential diagnosis of headache. CT and MRI are the best tools in diagnosis of isolated sphenoiditis.