Abstract
A 59-year-old male who presented with a nonspecific headache at the vertex, resembling retrobulbar optic neuritis, was treated as such but did not show any improvement. Although optic nerve compression from sphenoid mucocele was finally discovered, the delayed diagnosis and improper treatment led to a permanent visual loss. Optic neuritis could be caused by a common problem, “mucocele/sinusitis,” but might be easily overlooked in general practice. Rhinogenic optic neuropathy should, therefore, be considered in every case of optic neuritis whenever atypical presentation occurs or is unresponsive to high-dose steroid treatment.
Highlights
A 59-year-old healthy male presented with a nonspecific headache at the vertex followed by sudden painless visual loss of the right eye
Because of the anatomical correlation, sinus infection of Onodi cells can lead to inflammation/infection of the optic nerve, so-called ”rhinogenic optic neuropathy” [2, 5, 7]
Rhinogenic optic neuritis should be one of the differential diagnoses in patient presenting with atypical neuritis
Summary
A 59-year-old healthy male presented with a nonspecific headache at the vertex followed by sudden painless visual loss of the right eye. Magnetic resonance imaging (MRI) of the brain and orbit performed 2 days after the headache incident revealed minimal fluid surrounding the optic nerve sheath suggestive of mild swelling of the optic nerve sheath papilledema. Thinner slice and contrasted study should have been performed for the definite diagnosis of optic neuritis. Two weeks later, another MRI of the brain and orbit demonstrated focal hyposignal T1/hypersignal T2 retention cyst, adhering to the right lateral sphenoidal wall, around the right optic nerve canal with mild surrounding enhancement, along the mucosa and around the optic nerve canal, and focal mild swelling with ill-defined hypersignal T2 change and faint enhancement of the corresponding intracanalicular portion of the right optic nerve. The patient showed no improvement after the surgery, probably because of the long period of compression as evidenced by the presence of optic atrophy
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