Sphenoid sinus mucocele as a cause of isolated pupil-sparing oculomotor nerve palsy mimicking diabetic ophthalmoplegia

December 20, 2013
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A 37-year-old woman presented with isolated right-sided oculomotor nerve palsy. Neurologic examination revealed no other disorder. Computed tomography of the paranasal sinuses demonstrated complete opacification of the sphenoid sinus. Dense mucoid fluid was drained from the sphenoid sinus via an endoscopic transseptal sphenoidotomy. A biopsy confirmed the diagnosis of sphenoid sinus mucocele. At follow-up 4 weeks postoperatively, the patient's ocular symptoms were markedly alleviated. Considering rare causes of isolated oculomotor nerve palsy, such as sphenoid sinus mucocele, is important in the differential diagnosis, even in patients with well-known risk factors such as diabetes mellitus.


Isolated palsy of the oculomotor nerve (cranial nerve III) is seen in association with neoplasms, trauma, infarctions, hemorrhages, demyelination, aneurysms, inflammations, ischemias, infections, and uncal herniations.1 Mucoceles occur as a consequence of long-standing sinusitis; they may arise when any lesion blocks the normal outflow of mucus from a sinus cavity. Symptoms occur when a mucocele impinges on surrounding structures.2

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