Sphenoid Sinusitis Associated with Meningitis, Visual Disturbances and Total Ophthalmoplegia

The sphenoid sinus is deeply situated in the nasal cavity and infection of this sinus is less common than infections of other sinuses. Accordingly, sphenoid sinus infections are frequently misdiagnosed on initial evaluation. The walls of this sinus are adjacent to the pituitary gland, optic nerve and cavernous sinuses. A case of sphenoid sinusitis associated with meningitis, visual disturbances and total ophthalmoplegia was reported. The patient, a 58 year-old female, complained of visual disturbances and deep pain in both retroorbital regions. On admission, the neurological examination revealed a bilateral choked disc with III rd, IV th, V th and VI th cranial nerve palsies. The cerebrospinal fluid was clear with a pressure of 280 mmH2O, and contained 93 cells per mm3., consisting mainly of lymphocytes. The sugar content was 55 mg /dl and the protein content was 344 mg/dl. CT and MRI showed that the sphenoid sinus was filled with pus, but there was no evidence of bone destruction. Surgical drainage was performed for the sphenoid sinusitis. The CSF findings returned to the normal ranges, but the visual disturbance and total ophthalmoplegia still remained, two months after the drainage. The shenoid sinusitis can easily spread to the pituitary gland, optic nerve and cavernous sinuses, and result in serious irreversible neurologic complications. This case demonstrates that early diagnosis and treatment are important.