Large mucocele with intracranial and intraorbital extension

Abstract

Case summary A 26-year-old female had had progressive right eye blindness for 13 years. She did not have any other complaints such as headache, seizure, or weakness. At that time she was admitted to a local hospital and Computed tomography (CT) imaging was performed, showing a mass at left maxillary sinus with extracranial extension. The caring physician advised surgery but her family refused due to financial problem. A year later, she developed complete bilateral eye blindness and the subsequent CT revealed larger size of the mass. She was referred to a tertiary hospital for surgery but she lost follow-up. In this visit, she had foul-smelling discharge per left nostril without fever for 2 weeks followed by seizure and headache for 2 days. She had no underlying disease, no history of seizure and head trauma. Physical examination revealed that her vital signs were normal; body temperature of 36.7*c, blood pressure of 100/69 mmHg, pulse rate of 110/ minute, and respiratory rate of 24/ minute. Both pupils were dilated (8 mm/ 8 mm). Light reflexes were diminished in both eyes as well as proptosis with more severity in the left eye. The fundus scope showed bilateral markedly pale discs. There was a mass protruding outside both nostrils. The cranial nerve examination and neurological examinations were normal. Laboratory investigation for hormonal levels (Free-T4, TSH, HGH cortisol, FSH, LH, prolactin) were all in normal ranges.Thanatta Seemai, M.D.From The Department of Radiology, Faculty of Medicine,Prince of Songkla University, Songkhla, ThailandAddress correspondence T.S.(e-mail:thanatta.seemai@gmail.com)