Bilateral visual loss and ipsilateral ophthalmoplegia due to unilateral sphenoid sinus mucocele

Abstract

Bilateral impaired visual acuity, unilateral oculomotor and trochlear nerve paresis, and headache due to sphenoid sinus mucocele is rare. An 81-year-old woman developed bilateral headache, left-sided ptosis, bilateral visual impairment, diplopia, and rhinorrhea. Neurologic examination revealed bilaterally reduced visual acuity and left-sided paresis of the oculomotor and trochlear nerves. Spiral CT and T2-weighted MRI of the perinasal sinuses revealed a left-sided sphenoid sinus mucocele with bony destruction of the surrounding walls and involvement of the orbital apex. Endonasal transsphenoidal drainage of the mucocele led to a complete recovery of the cranial nerve palsies and marked improvement of visual acuity. Sphenoid sinus mucocele can present with bilateral visual loss and unilateral oculomotor and trochlear nerve paresis. Endoscopic drainage of the mucocele can lead to almost complete recovery.