Oculomotor nerve palsy as the initial presentation of fungal sinusitis. A case report
Abstract Introduction and objective: isolated third cranial nerve palsy as the initial manifestation of fungal sinusitis is extremely rare. By describing this case, we aim to aid in diagnosis and raise clinical suspicion, preventing diagnostic delays. Case description: We present the case of an 84-year-old male patient who presented with right hemicranial headache persisting for one month and right eyelid ptosis evolving over two days. Clinical examination revealed incomplete third cranial nerve palsy with preserved pupillary function. Imaging studies showed occupation of the right sphenoid sinus with erosion of the intersinusal septum and extension to the contralateral sinus, suggesting a mucocele with associated bone hyperostosis. The patient underwent right sphenoidotomy, leading to the recovery of extraocular muscle mobility and resolution of ptosis. Discussion/Conclusions: we aim to highlight the diagnostic and therapeutic process, as well as the patient’s clinical evolution, to facilitate the recognition and diagnosis of this condition.
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J-M Thomassin, A, Paganelli, J, Michel, P. Dessi. Micosis rinosinusales. En: Enciclopedia médico-quirúrgica. Elsevier Masson SAS.; 2016.
Martin TJ, Smith TL, Smith MM, Loehrl TA. Evaluation and Surgical Management of Isolated Sphenoid Sinus Disease. Arch Otolaryngol Neck Surg. 1 de diciembre de 2002;128(12):1413.
Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H. Bola fúngica sinusal: análisis de nuestra casuística. Acta Otorrinolaringológica Esp. julio de 2016;67(4):220-225.
Ledderose GJ, Braun T, Betz CS, Stelter K, Leunig A. Functional endoscopic surgery of paranasal fungus ball: clinical outcome, patient benefit and health-related quality of life. Eur Arch Otorhinolaryngol. octubre de 2012;269(10):2203-2208.
El Mograbi A, Soudry E. Ocular cranial nerve palsies secondary to sphenoid sinusitis. World J Otorhinolaryngol - Head Neck Surg. marzo de 2017;3(1):49-53.
Van Alyea OE. Sphenoid sinus: anatomic study, with consideration of the clinical significance of the structural characteristics of the sphenoid sinus. Arch Otolaryngol - Head Neck Surg. 1 de agosto de 1941;34(2):225-253.
Castelnuovo P, Pagella F, Semino L, Bernardi FD, Delù G. Endoscopic treatment of the isolated sphenoid sinus lesions.
Sethi DS. Isolated Sphenoid Lesions: Diagnosis and Management. Otolaryngol Neck Surg. mayo de 1999;120(5):730-736.
Reyes-Rodríguez AA, García-Cázares N, Caballero-Espinoza D, Castro-Palos JS, Arreola-Rosales RL, Escanio-Cortés ME. Síndrome de seno cavernoso secundario a mucocele esfenoidal. Rev Mex Oftalmol. julio de 2015;89(3):183-188.
Lee JC, Park SK, Jang DK, Han YM. Isolated Sphenoid Sinus Mucocele Presenting as Third Nerve Palsy. J Korean Neurosurg Soc. 2010;48(4):360.
Dores LA, Simão MA, Marques MC, Dias Ó. Parésia do Nervo Motor Ocular Comum em Contexto de Sinusite Esfenoidal. Acta Médica Port. 30 de diciembre de 2014;27(6):782-786.
Chen L, Jiang L, Yang B, Subramanian PS. Clinical features of visual disturbances secondary to isolated sphenoid sinus inflammatory diseases. BMC Ophthalmol. diciembre de 2017;17(1):237.
Lee DH, Yoon TM, Lee JK, Joo YE, Park KH, Lim SC. Invasive Fungal Sinusitis of the Sphenoid Sinus. Clin Exp Otorhinolaryngol. 2014;7(3):181.
Tsai RK, He MS, Cheu CL, Sheu MM. Transient Third Cranial Nerve Palsy Caused by Sphenoid Sinus Aspergillosis. J Neuroophthalmol. septiembre de 2008;28(3):239-240.
Reis-Rego Â, Pinto A, Almeida E Sousa C. Fungus ball within a mucocele of the sphenoid sinus: A rare entity. Acta Otorrinolaringológica Esp. septiembre de 2020;71(5):326-327.
Martin TJ, Smith TL, Smith MM, Loehrl TA. Evaluation and Surgical Management of Isolated Sphenoid Sinus Disease. Arch Otolaryngol Neck Surg. 1 de diciembre de 2002;128(12):1413.
Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H. Bola fúngica sinusal: análisis de nuestra casuística. Acta Otorrinolaringológica Esp. julio de 2016;67(4):220-225.
Ledderose GJ, Braun T, Betz CS, Stelter K, Leunig A. Functional endoscopic surgery of paranasal fungus ball: clinical outcome, patient benefit and health-related quality of life. Eur Arch Otorhinolaryngol. octubre de 2012;269(10):2203-2208.
El Mograbi A, Soudry E. Ocular cranial nerve palsies secondary to sphenoid sinusitis. World J Otorhinolaryngol - Head Neck Surg. marzo de 2017;3(1):49-53.
Van Alyea OE. Sphenoid sinus: anatomic study, with consideration of the clinical significance of the structural characteristics of the sphenoid sinus. Arch Otolaryngol - Head Neck Surg. 1 de agosto de 1941;34(2):225-253.
Castelnuovo P, Pagella F, Semino L, Bernardi FD, Delù G. Endoscopic treatment of the isolated sphenoid sinus lesions.
Sethi DS. Isolated Sphenoid Lesions: Diagnosis and Management. Otolaryngol Neck Surg. mayo de 1999;120(5):730-736.
Reyes-Rodríguez AA, García-Cázares N, Caballero-Espinoza D, Castro-Palos JS, Arreola-Rosales RL, Escanio-Cortés ME. Síndrome de seno cavernoso secundario a mucocele esfenoidal. Rev Mex Oftalmol. julio de 2015;89(3):183-188.
Lee JC, Park SK, Jang DK, Han YM. Isolated Sphenoid Sinus Mucocele Presenting as Third Nerve Palsy. J Korean Neurosurg Soc. 2010;48(4):360.
Dores LA, Simão MA, Marques MC, Dias Ó. Parésia do Nervo Motor Ocular Comum em Contexto de Sinusite Esfenoidal. Acta Médica Port. 30 de diciembre de 2014;27(6):782-786.
Chen L, Jiang L, Yang B, Subramanian PS. Clinical features of visual disturbances secondary to isolated sphenoid sinus inflammatory diseases. BMC Ophthalmol. diciembre de 2017;17(1):237.
Lee DH, Yoon TM, Lee JK, Joo YE, Park KH, Lim SC. Invasive Fungal Sinusitis of the Sphenoid Sinus. Clin Exp Otorhinolaryngol. 2014;7(3):181.
Tsai RK, He MS, Cheu CL, Sheu MM. Transient Third Cranial Nerve Palsy Caused by Sphenoid Sinus Aspergillosis. J Neuroophthalmol. septiembre de 2008;28(3):239-240.
Reis-Rego Â, Pinto A, Almeida E Sousa C. Fungus ball within a mucocele of the sphenoid sinus: A rare entity. Acta Otorrinolaringológica Esp. septiembre de 2020;71(5):326-327.
Rodríguez García, A., Manzanares López-Rendo, C., Martín González, A., Clement Alonso, L., Fernández Cascón, S., & Martín Sigüenza, G. (2025). Oculomotor nerve palsy as the initial presentation of fungal sinusitis. A case report. Revista ORL, e33035. https://doi.org/10.14201/orl.33035
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