Recurrent contralateral abducens nerve palsy in acute unilateral sphenoiditis

Nidhi Gupta, MDa, Michelle A. Michel, MDab, David M. Poetker, MD, MAa
Received 21 February 2009 published online 04 June 2009.
American Journal of Otolaryngology

Abstract
Objective
We describe a patient who presented with recurrent, contralateral abducens nerve palsy resulting from acute sphenoiditis.

Methods
Patient medical record and imaging studies were reviewed. A literature review of complications of sphenoiditis was performed.

Results
Our patient presented with symptoms consistent with an upper respiratory tract infection, as well as severe headache, disequilibrium, and diplopia. Physical examination demonstrated left-sided sixth cranial nerve palsy. Imaging studies were consistent with right sphenoid sinus inflammatory disease. Her medical history was significant for a similar episode 9 years previously, which was managed medically. The current episode was treated acutely with antibiotics and prednisone. Upon resolution of her symptoms, she underwent an endoscopic sphenoidotomy.

Conclusions
Although cranial nerve palsies associated with isolated sphenoiditis have been reported, we describe a unique case of recurrent isolated sphenoiditis causing contralateral abducens nerve palsy. Acute management can be medical, with surgical therapy reserved for refractory cases or to prevent future episodes.


Thanks.

I really do appreciate your efforts to spread knowledge..

I am reminded of a case I had in the late 80s. A child with idiopathic
abducent nerve palsy (unilateral). It passed away in a couple of days,
and we were clueless.. in that era/area without CT ;-)
Now I am wiser!

Thanks and regds,

Thomas Antony
Yemen