Department of Otorhinolaryngology - Head and Neck Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
Department of Ophthalmology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
J Int Med Res. 2024 Sep;52(9):3000605241274587. doi: 10.1177/03000605241274587.
The abducens nerve, which is vulnerable because of its complex anatomy at the skull base, is seldom affected by acute or severe sphenoid sinusitis. Notably, abducens nerve palsy following asymptomatic chronic rhinosinusitis (CRS) in a healthy young individual after a mild upper respiratory infection (URI) remains undocumented in the literature. Herein, we report a case of acute unilateral abducens neuropathy in a healthy 35-year-old woman with CRS in the ipsilateral sphenoid sinus, following a mild URI 2 weeks earlier. She presented with sudden-onset diplopia, was afebrile, and had normal serum inflammatory biomarkers. Comprehensive ophthalmological and neurological exams revealed no abnormalities except limited lateral gaze in the left eye. Imaging revealed mucosal swelling on the hyperpneumatized left sphenoid sinus, which thinned the clivus and positioned the inflamed mucosa close to the Dorello's canal, likely facilitating the spread of inflammation to the ipsilateral abducens nerve. Urgent endoscopic sinus surgery combined with systemic corticosteroids and antibiotics led to complete resolution by postoperative day 10. The present case demonstrates acute abducens nerve neuropathy from URI-induced exacerbation of sphenoid sinus CRS with specific anatomical predispositions.
展神经因其在颅底的复杂解剖结构而容易受损，很少受到急性或严重蝶窦炎的影响。值得注意的是，文献中尚未记载无症状慢性鼻-鼻窦炎（CRS）患者在轻度上呼吸道感染（URI）后，健康年轻个体出现单侧展神经麻痹。在此，我们报告了一例健康的 35 岁女性病例，其在 2 周前轻度 URI 后同侧蝶窦发生 CRS，出现急性单侧展神经神经病。她突发复视，无发热，血清炎症标志物正常。全面的眼科和神经科检查除左眼外展受限外无异常。影像学显示左侧过度充气的蝶窦黏膜肿胀，使斜坡变薄，炎症黏膜靠近 Dorello 管，可能使炎症更容易扩散至同侧展神经。紧急鼻内镜鼻窦手术联合全身皮质类固醇和抗生素治疗，术后第 10 天完全缓解。本病例显示，URI 加重具有特定解剖学倾向的蝶窦 CRS 可引起急性展神经神经病。
