非侵入孤發性之蝶竇麴菌症造成的單側性外展神經麻痺

Unilateral Abducens Nerve Palsy Caused By Isolated Noninvasive Sphenoidal Aspergillosis

前言:孤發性蝶竇之非侵入性麴菌症(isolated aspergillo-sphenoiditis)是一種臨床上少見的疾病。感染所造成的症狀常常是廣泛且不具辨識性的。尤其是造成單側突發性外展神經麻痺的病例十分罕見。
病例:一位 68 歲的女病人,3 天前突然開始產生雙眼複視以及輕微頭痛在左額葉,以及左側眼眶週圍區域。神經學檢查發現她的左眼外展神經運動受到限制。不過她的視覺和色彩對比度都是正常的。核磁共振的報告顯示左側有蝶竇炎。
討論:病人入院後接受左側功能性鼻內視鏡手術。在手術的過程中,當我們把蝶竇打開並引流時,發現裡面了麴菌的感染。同時在術後的第一天後病人複視的情形很快就恢復了,並在一月後完全的緩解。孤發性蝶竇之非侵入性麴菌症是造成外展神經麻痺的一個不尋常的原因。及時診斷和積極治療是必要的。

Introduction: We report an unusual case of isolated aspergillo-sphenoiditis in a 68-year-old female who presented with left-sided abducens nerve palsy (ANP) and headache.
Case History: A 68-year-old female patient suffered from sudden onset of diplopia and progressive mild headache in the left frontal, periorbital, and retro-orbital regions for three days. Neurologic examination showed limited left eye abduction. Her vision and color contrast were normal. The MRI showed left side sphenoid sinusitis. The patient was admitted and received Functional Endoscopic Sinus Surgery (FESS). The sphenoid sinus was opened wide and many fungus balls were found inside.
Results: Her diplopia recovered the day after surgery and reached complete remission at one month follow up.
Discussion: Isolated aspergillo-sphenoiditis can be an unusual cause of abducens nerve palsy. Prompt diagnosis and aggressive treatment are required in such cases.