[Recurrent unilateral painful oculomotor nerve palsy with an ipsilateral posterior ethmoidal mucocele]

We presented a case of 6 episodes of the right painful oculomotor nerve palsy for 10 years, accompanied by a posterior ethmoidal mucocele on the same side. No destructive bone lesions were shown on every recurrence with the brain CT. For the pathogenesis of neurological involvement in cases of mucocele, either the direct compression by an expanding mucocele or the inflammatory infiltration from a mucocele has been considered. In this case the latter mechanism is considered to be responsible for the etiology of the painful oculomotor nerve palsy. Cases of the painful oculomotor nerve palsy with paranasal lesion or history of parasinusitis are characterized by (1) predominant in male, (2) neurological manifestations unilaterally on the same side of paranasal lesion, and (3) frequent recurrence of neurological symptoms.