[Sphenoid sinus aspergillosis presenting abducens nerve palsy and visual field impairment; a case report]

A case of sphenoid sinus aspergillosis presenting abducens nerve palsy and visual field impairment is reported. A 73-year-old woman visited our hospital with the complaint of head heaviness on the 27th of March, 1989. Although results of neurological examinations were normal, craniogram revealed the destruction of the clivus, and CT scan and MRI showed a mass lesion, which was thought to be a mucocele in the sphenoid sinus. On the 1st of September, she developed right abducens nerve palsy and visual field impairment. MRI performed on the same day showed an enlargement of the mass lesion in the sphenoid sinus. In order to decompress the involved cranial nerves, her sphenoid sinus was explored on the 22nd of September. The sphenoid sinus was filled with purulent fluid and yellowish mass. Histopathological examination revealed colonies of aspergillus fumigatus. Fluconazole, a new antifungal drug, was given for 34 days postoperatively. The right abducens nerve palsy and the visual field impairment gradually improved along with a reduction of the mass lesion in her sphenoid sinus. Sphenoid sinus aspergillosis is a rare disease. Its diagnosis is difficult. However, MRI can show a specific low signal intensity in T2-weighted image. Also in our case, MRI on the first admission showed a definite low signal intensity in some parts of the lesion, which exhibited a high intensity later on during the second administration, probably due to a qualitative change. To our knowledge, only 33 such cases have been previously reported. Intracranial involvement occasionally occurs in this disease. In its early stage, cranial nerve palsies are caused by nerve compression or invasion by this disease.(ABSTRACT TRUNCATED AT 250 WORDS)