Invasive fungal sphenoid sinusitis is a rare and potential life threating disease. An incidence rate of fungal sphenoiditis among patients with isolated sphenoid disease varies from 4.5% to 26.8%. Generally the symptoms of sphenoid sinusitis are non-specific and include headaches, visual disorder, post nasal drip, nasal obstruction and paralysis or paresis of single or multiplicitous cranial nerves. In this study, a case of isolated invasive fungal left sphenoiditis in immunocompetent 56-year-old woman is described. The first sinus computed tomography (CT) examination revealed complete opacification of the left sphenoid sinus, she second CT scans showed also erosions of the sphenoid sinus bony walls. Endoscopic sinus surgery was performed and intraoperatively fixed and dilated left pupil was observed thus surgery team decided to finish an operation immediately. Ophthalmologist diagnosed the left oculomotor nerve paresis. Pathologic analysis demonstrated fungal hyphae morphologically identical to Aspergillus spp. Due to suspicion of cerebrospinal fluid (CSF) leak, increasing pneumocephalus and manifestation of mental changes in our subject, endoscopic reoperation with CFS fistula closure was done nine days after the first operation. The patient was treated with intravenous voriconazole and ceftriaxone for one month, and after discharge with itraconazole for 3 months. The full recovery of the left oculomotor nerve function ensued 4 months after surgery and no signs of recurrence of the fungal disease were present up to date.
EHMTI-0142. Features of the headache secondary to unruptured intracranial aneurysm with oculomotor nerve paresis
