Fig 1 - available via license: CC BY-NC
Content may be subject to copyright.
a Preoperative ptosis. b Preoperative palsy looking upwards. c Preoperative palsy of adduction. d-f Postoperative status with normal eye movements.
Source publication
Horner syndrome is described in this case report as a rare complication of bacterial sphenoid sinusitis. A patient presented with miosis, ptosis, and ophthalmic nerve palsy with acute sphenoid sinusistis and cavernous sinus thrombosis on MRI. The impairment of sympathetic fiberscan can be explained through the direct septic effects of the sphenoid...
Similar publications
Cavernous sinus thrombosis (CST) can develop as a result of both infectious and noninfectious conditions. Infections in the middle part of the face caused by Staphylococcus aureus are the most common cause of septic thrombosis of the cavernous sinuses. Paranasal (typically sphenoid) sinusitis, dental abscess, and, less commonly, otitis media are ot...
Citations
... The latter can be divided into orbital, orbital apex, bony and other complications. The infection of the skull base or regions outside the confines of paranasal sinuses (i.e., invasive form) and the involvement of the central nervous system are more common in immunocompromised than immunocompetent patients [9][10][11][12]. Table 1. ...
... Table 1. Classification of rhinosinusitis complications [6,[9][10][11][12][13][14][15][16][17]. Since there is a paucity of literature describing rare and severe complications of RS, this paper presents a literature review (Table 2) and a case of a patient with an orbital apex syndrome (Jacod's syndrome), Horner syndrome, and pterygopalatine fossa infection due to the acute invasive fungal RS, which developed from sphenoid sinus fungal ball. ...
... It typically comprises ipsilateral upper eyelid ptosis, myosis and sometimes facial anhidrosis due to the damage in the sympathetic pathway. Pupillary responses are normal [12,16]. Another possible cause of diplopia is the myositis of extraocular muscles [32]. ...
This paper presents a literature review and a case of an 83-year-old otherwise healthy female patient with a history of recent syncope, a sudden-onset right-sided temporal headache, diplopia, and vision loss. An exam revealed right-sided upper eyelid ptosis, myosis, vision loss, ophthalmoplegia, and a positive relative afferent pupillary defect on the right eye. CT showed sphenoid sinus opacification, eroded lateral sinus wall, Vidian canal, disease extension to the posterior ethmoid air cells, orbital apex, medial orbital wall, and pterygopalatine fossa. An orbital apex syndrome (Jacod's syndrome), Horner syndrome, and pterygopalatine fossa infection were diagnosed due to the acute invasive fungal sinusitis developed from a sphenoid sinus fungal ball. The patient was treated with antimicrobial therapy and transnasal endoscopic surgery twice to decompress the orbital apex, drain the abscess and obtain specimens for analysis. The right-sided ptosis, visual loss, ophthalmoplegia, and headache resolved entirely. No immune or comorbid diseases were identified, microbiological and histopathological analyses were negative, and MRI could not be performed on the presented patient. For that reason, the diagnostic procedure was non-standard. Nevertheless, the treatment outcome of this vision and life-threatening disease was satisfactory. Treating the fungal ball in an older or immunocompromised patient is essential to prevent invasive fungal rhinosinusitis and fatal complications.
... Meanwhile, sphenoid sinusitis can present with various neurological symptoms due to its anatomical location and proximity to crucial neurovascular structures. Rare cases of septic cavernous sinus thrombosis, isolated abducens nerve palsy, and even Horner's syndrome have been reported in the literature (5). However, MFS masquerading as sphenoid sinusitis is exceptionally scarce, with only a single case reported to date (2). ...
Background: Miller Fisher Syndrome is a variant of Guillain-Barre Syndrome, classically characterized by the triad of ataxia, areflexia and ophthalmoplegia. However, many conditions can mask the presentation of Miller Fisher Syndrome, potentially leading to grave consequences due to delayed diagnosis or even misdiagnosis.
Case Report: We describe a case of Miller Fisher Syndrome mimicking acute sphenoid sinusitis with intracranial complications in an otherwise healthy 19-year-old man. Accurate diagnosis with prompt treatment led to full clinical recovery
of our patient.
Conclusion: Sphenoid sinusitis warrants great vigilance and thorough neurological examination due to its proximity to structures such as the cavernous sinus and its associated cranial nerves. This case highlights its potential to mask more devastating conditions like Miller Fisher Syndrome and the successful role of medical management without the need for sphenoidotomy
... Many studies have reported temporary ptosis caused by compression or damage of the oculomotor nerve via lid trauma, sphenoid sinus inflammation, pituitary tumor, intracranial vasculopathy, and neurosurgery [4][5][6][7] . However, reports on ptosis caused by oculomotor nerve palsy after reconstruction of orbital wall fracture are rare [1][2][3] , and there is no prior report of ptosis combined with severe medial and superior rectus palsy. ...
... In this context, a few cases of HS secondary to a sinus infection have been reported in the literature. To the authors' knowledge, there are only two case reports of individuals who developed sinusitis and Horner's syndrome [3,4]. But, the present case is probably the first to present with isolated HS features. ...
... HS secondary to sinus infection was rarely reported in the literature. We identified two cases published in English, and we compared it with the present case (Table 1) [3,4]. Nevertheless, the present case was the first to describe a subject with isolated HS after a rhinosinusitis episode. ...
... Another important fact in the study of Käcker and colleagues is that the individual had sinusitis, which might have triggered HS and oculomotor nerve palsy [4]. In this context, this presentation could be described as, which is characterized by unilateral HS associated with ipsilateral sensory and/or motor abnormalities in the distribution of the 5th cranial nerve fibers [11]. ...
Background
Horner’s syndrome (HS) is characterized by unilateral ptosis, ipsilateral miosis with normally reactive pupil, and in some cases, ipsilateral facial anhidrosis.
Case presentation
We report an adult male presenting with ptosis. Neurological examination revealed ptosis and miosis in the right eye. Anhidrosis was not observed, and the patient did not complain about it. Laboratory tests were within normal limits. He had searched a general practitioner because of purulent nasal discharge, nasal obstruction, and anosmia. He was diagnosed with acute rhinosinusitis. Symptomatic treatment was started. The subject had full recovery of the nasal symptoms, but his right upper eyelid was drooping progressively. In the follow-up, after the third month, the patient was recovering from ptosis and miosis. In 1 year, the ptosis was minor with less than 1 mm and miosis was no more observed.
Discussion
A few cases of HS secondary to a sinus infection have been reported in the literature. To the authors’ knowledge, there are only two case reports of individuals who developed sinusitis and Horner’s syndrome. The present case is the first to present isolated HS features. Our report suggests that sinusitis should be listed as a probable cause of isolated Horner’s syndrome. Moreover, patients presenting with this presentation probably have a good prognosis.
