A case of Bilateral Near Blindness Secondary to Isolated Sphenoid Sinus Aspergillosis with Headache

양측성 실명을 동반한 접형동 아스페르길루스증 1 예

  • Yoon, Jun-Pil (Department of Neurology, College of Medicine, Yeungnam University) ;
  • Lee, Se-Jin (Department of Neurology, College of Medicine, Yeungnam University) ;
  • Lee, Jun (Department of Neurology, College of Medicine, Yeungnam University) ;
  • Kim, Ju-Hyun (Department of Neurology, College of Medicine, Yeungnam University) ;
  • Noh, Hyun-Doo (Department of Neurology, College of Medicine, Yeungnam University)
  • 윤준필 (영남대학교 의과대학 신경과학교실) ;
  • 이세진 (영남대학교 의과대학 신경과학교실) ;
  • 이준 (영남대학교 의과대학 신경과학교실) ;
  • 김주현 (영남대학교 의과대학 신경과학교실) ;
  • 노현두 (영남대학교 의과대학 신경과학교실)
  • Published : 2007.06.30

Abstract

Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.

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