Right Sided Sphenoid Fungal Sinusitis Presenting with Contralateral Abducens Paralysis: A Rare Case Report

Abstract

Abstract Isolated sphenoid sinus disease can be difficult to diagnose and treat due to the non-specificity of their symptoms and to the likelihood that these pathologies can present late with complications. For these reasons, significant delays in the diagnosis and treatment of the patient may happen. In addition, due to the proximity of the sphenoid sinus to vital structures such as the optic nerve, internal carotid artery, cavernous sinus and cranial nerves, any delay in treatment has the potential to lead to catastrophic outcomes, which is why swift diagnosis and early treatment are of the essence. In the differential diagnosis of isolated sixth cranial nerve palsy, sphenoid sinus pathologies must be kept in mind and the patients worked up with CT and/or MRI. Swift diagnosis and treatment before intracranial progression occurs could prevent severe complications. In our case report, we present a patient with isolated right sphenoid sinus aspergilloma (fungus ball) presenting with hemicranial headache and contralateral 6th cranial nerve involvement. In the literature, ipsilateral 6th cranial nerve involvement secondary to sphenoid sinusitis has been commonly reported, however so far only two cases of contralateral cranial nerve involvement have been reported, therefore our case represents a very rare presentation of a rare pathology. The patient has been operated with an endoscopic transnasal approach and in her postoperative follow up, lateral gaze function of the left eye has been observed to be significantly improved. Our case underlines the importance of considering sphenoid sinus aspergillomas in the differential diagnosis of patients presenting with unexplained cranial nerve pathologies, especially in the presence of headache, and the importance of early radiological studies and early operative treatment in these patients.