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K.R. Pugh, R. Trespalacios; A Diagnostic Dilemma: Bilateral Multiple Cranial Nerve Palsies in a Patient With Aseptic Meningitis, Sphenoid Sinusitis, and a Suprasellar Mass . Invest. Ophthalmol. Vis. Sci. 2005;46(13):621.
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To describe an unusual case presentation involving bilateral multiple cranial nerve palsies in a patient with aseptic meningitis, evolving sphenoid sinusitis, and a suprasellar mass.
The clinical presentation, work–up (including photographs and neuroimaging) and differential diagnoses are discussed in detail.
The patient presented with the worst headache of her life, including nausea and vomiting. She was admitted for rule–out sub–arachnoid hemorrhage, and subsequently found to have aseptic meningitis. Three days into her hospital stay, ocular examination revealed a pupil–involving frozen left globe, and right–sided CNVI palsy. The patient did not show additional signs of orbital apex syndrome on either side, nor did she display common signs of basilar meningitis. Neuroimaging revealed a cystic suprasellar mass (without cavernous sinus inflammation). The lesion was not biopsied. Cerebral angiography was negative for cavernous sinus involvement (aneurysm, apoplexy, fistula or thrombosis). Additional serological studies were non–elucidating. The patient's ocular symptoms and signs gradually resolved over the following two weeks in the hospital after only intravenous antibiotic therapy.
To our knowledge, this is the first case report of a patient exhibiting resolving bilateral cranial nerve palsies attributed to diagnoses of aseptic meningitis, sphenoid sinusitis and/or a suprasellar mass.
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