外転神経麻痺を発症し糖尿病性眼筋麻痺と鑑別困難であった副鼻腔炎例

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  • A Case of Abducens Nerve Palsy Caused by Sinusitis Indistinguishable from Diabetic Ophthalmoplegia
  • ガイテンシンケイ マヒ オ ハッショウ シ トウニョウビョウセイガンキン マヒ ト カンベツ コンナン デ アッタ フクビクウエンレイ

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<p>[Introduction] Cranial nerve palsies can occur as a complication of several diseases, such as diabetes mellitus, aneurysm, and sinusitis. We have encountered many cases in which we successfully identified the cause of the cranial nerve palsy, but later also found an additional etiologic factor. Thus, even in a patient with sinusitis developing a cranial nerve palsy, the palsy could be caused by a disease other than sinusitis.</p><p>[Case] A 53-year-old man with diabetes mellitus receiving insulin therapy visited an ophthalmologist with a several day’s history of diplopia. He was diagnosed as having left abducens nerve palsy, and imaging examination revealed sinus lesions, so that he was referred to our otorhinolaryngology department. Paranasal sinus computed tomography showed left pan-sinusitis and a high-density area in the sphenoid sinus. He was admitted to the hospital with a diagnosis of abducens nerve palsy complicating bacterial or fungal sinusitis. He was initiated on treatment with antibiotics, but the symptoms persisted. Subsequently, he underwent left endoscopic sinus surgery. Inflammatory polyps and purulent nasal discharge were found in the left paranasal sinuses. There were no fungal lesions or bone defects. We opened and cleaned all the paranasal sinuses. As his diabetes mellitus was poorly controlled (HbA1c 11%), we did not initiate the patient on steroid therapy. The mucosa of the sinuses returned to normal soon after the surgery, and the abducens nerve palsy improved by 3 months after the surgery.</p><p>[Conclusion] The patient’s left abducens nerve palsy could have been caused by the acute sinusitis, but it could also be attributable to diabetic ophthalmoplegia. In a case of sinusitis developing cranial nerve palsy, we should bear in mind that various diseases other than sinusitis could also cause cranial nerve palsy.</p>

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