Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Pathology, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, USA.
BMJ Case Rep. 2021 Mar 15;14(3):e240460. doi: 10.1136/bcr-2020-240460.
A 67-year-old man presented with progressive diplopia. On evaluation, he was noted to have bilateral palsies of cranial nerves III, IV and VI as well as a unilateral right true vocal fold paralysis. CT and MRI studies demonstrated a T2-bright left ethmoid mass with no evidence of bony erosion. Direct visualisation demonstrated a polypoid appearing mass of the left sphenoethmoid recess. Operative biopsy was pursued with final pathology demonstrating benign seromucinous hamartoma. Subsequent blood work demonstrated high titres of anti-acetylcholine receptor antibodies consistent with myasthenia gravis. The patient was started on pyridostigmine with improvement in his ocular cranial neuropathies.
一位 67 岁男性因进行性复视就诊。评估时，发现他存在第三、第四和第六脑神经双侧麻痹以及右侧单侧真性声带麻痹。CT 和 MRI 研究显示左侧筛窦有 T2 亮区肿块，无骨侵蚀证据。直接可视化显示左侧蝶筛隐窝有息肉样肿块。行手术活检，最终病理诊断为良性浆液黏液性错构瘤。随后的血液检查显示乙酰胆碱受体抗体滴度高，符合重症肌无力。患者开始服用吡啶斯的明，其眼颅神经病得到改善。
