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变应性真菌性鼻窦炎继发外展神经麻痹

Abducens nerve palsy secondary to allergic fungal sinusitis.

作者信息

Alsaleh Majd A, Almomen Ali A

机构信息

Department of Otorhinolaryngology, Aljabr Eye and ENT Hospital, Alhassa 36422, Saudi Arabia.

Department of Otorhinolaryngology, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia.

出版信息

J Surg Case Rep. 2024 Nov 16;2024(11):rjae697. doi: 10.1093/jscr/rjae697. eCollection 2024 Nov.

DOI:10.1093/jscr/rjae697
PMID:39554389
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11570107/
Abstract

Allergic fungal rhinosinusitis (AFRS) stands out as the predominant form of fungal sinusitis, primarily attributable to a hypersensitive response to fungal invasion. AFRS Characterized by symptoms of rhinosinusitis. The expanding mass in the disease leads to bony restructuring and implicating adjacent anatomical structures. AFRS may extend beyond the sinus cavities, leading to compression of nearby structures like the orbit, optic and abducens nerves which leads to many complications such as nerve palsies and proptosis. Diagnosis of AFRS typically necessitates radiographic assessment initially, with histopathological examination serving as the confirmatory modality. The management of AFRS typically entails a multifaceted approach integrating surgical intervention alongside medical therapy. This case report illustrates a distinctive manifestation of abducens nerve palsy secondary to allergic fungal sinusitis which had dramatic improvement and resolution of the diplopia after the Endoscopic sinus surgery. Steroids and nasal saline irrigation have been prescribed post operatively to prevent the recurrence.

摘要

变应性真菌性鼻-鼻窦炎(AFRS)是真菌性鼻窦炎的主要形式,主要归因于对真菌侵袭的超敏反应。AFRS以鼻-鼻窦炎症状为特征。该病中的肿物不断扩大导致骨质重塑,并累及相邻解剖结构。AFRS可能会超出鼻窦腔范围,导致压迫附近结构,如眼眶、视神经和外展神经,从而引发许多并发症,如神经麻痹和眼球突出。AFRS的诊断通常首先需要进行影像学评估,组织病理学检查作为确诊手段。AFRS的治疗通常需要采取多方面方法,将手术干预与药物治疗相结合。本病例报告说明了变应性真菌性鼻窦炎继发外展神经麻痹的一种独特表现,在内镜鼻窦手术后复视得到显著改善并消失。术后已开具类固醇和鼻腔盐水冲洗处方以预防复发。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/1f8bcad523ff/rjae697f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/d94820c0ad22/rjae697f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/46c519d6aa4a/rjae697f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/7e07d5697e9a/rjae697f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/89c6f4f89091/rjae697f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/1f8bcad523ff/rjae697f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/d94820c0ad22/rjae697f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/46c519d6aa4a/rjae697f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/7e07d5697e9a/rjae697f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/89c6f4f89091/rjae697f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b566/11570107/1f8bcad523ff/rjae697f5.jpg

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本文引用的文献

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Acute Vision Loss in Patients With Allergic Fungal Rhinosinusitis: A Case Series.变应性真菌性鼻-鼻窦炎患者的急性视力丧失:病例系列
Ther Adv Allergy Rhinol. 2023 Dec 6;14:27534030231214400. doi: 10.1177/27534030231214400. eCollection 2023 Jan-Dec.
2
Bilateral proptosis-an unusual presentation of extensive allergic fungal sinusitis.双侧眼球突出——广泛变应性真菌性鼻窦炎的一种罕见表现。
J Surg Case Rep. 2022 Oct 21;2022(10):rjaa564. doi: 10.1093/jscr/rjaa564. eCollection 2022 Oct.
3
The Abducens Nerve: Anatomy and Pathology.外展神经:解剖与病理。
Semin Ultrasound CT MR. 2022 Oct;43(5):414-419. doi: 10.1053/j.sult.2022.04.008. Epub 2022 Apr 18.
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Allergic Fungal Rhinosinusitis in Saudi Arabia: A Review of Recent Literature.沙特阿拉伯的变应性真菌性鼻鼻窦炎:近期文献综述
Cureus. 2021 Dec 25;13(12):e20683. doi: 10.7759/cureus.20683. eCollection 2021 Dec.
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Clinical, Radiological, and Histopathological Patterns of Allergic Fungal Sinusitis: A Single-Center Retrospective Study.变应性真菌性鼻窦炎的临床、影像学和组织病理学特征:一项单中心回顾性研究
Cureus. 2020 Jul 17;12(7):e9233. doi: 10.7759/cureus.9233.
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Ocular cranial nerve palsies secondary to sphenoid sinusitis.蝶窦炎继发的眼部颅神经麻痹
World J Otorhinolaryngol Head Neck Surg. 2017 Mar 6;3(1):49-53. doi: 10.1016/j.wjorl.2017.02.001. eCollection 2017 Mar.
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Prognosis for sixth nerve palsy arising from paranasal sinus disease.第六脑神经麻痹源于鼻窦疾病的预后。
Am J Rhinol Allergy. 2013 Sep-Oct;27(5):432-5. doi: 10.2500/ajra.2013.27.3943.
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Acta Neurochir (Wien). 2009 Jul;151(7):733-8; discussion 738. doi: 10.1007/s00701-009-0312-7. Epub 2009 Apr 22.
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Otolaryngol Head Neck Surg. 1994 Nov;111(5):580-8. doi: 10.1177/019459989411100508.