Clinical Rhinology

Register      Login

VOLUME 13 , ISSUE 1 ( January-April, 2020 ) > List of Articles


Symptoms of Ocular Myasthenia Gravis Masked by an Organic Lesion in Sphenoid Sinuses

Rajeshwary Aroor, Marina Saldanha, Sharik Mustafa, Thayyezhuth Devika

Citation Information : Aroor R, Saldanha M, Mustafa S, Devika T. Symptoms of Ocular Myasthenia Gravis Masked by an Organic Lesion in Sphenoid Sinuses. Clin Rhinol An Int J 2020; 13 (1):18-20.

DOI: 10.5005/jp-journals-10013-1369

License: CC BY-NC 4.0

Published Online: 01-04-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Otolaryngologist tends to assume that the cranial nerve palsy is due to local causes, but it is important to overlook the symptoms to rule out other neurological causes too. Here, we present a 79-year-old elderly man, diabetic, who presented to our department with ophthalmoplegia along with contrast-enhanced computed tomography scan of nose and paranasal sinuses did in another hospital showing suspected mass lesion in bilateral sphenoid sinuses with the expansion of the sinus wall and erosion of the posteromedial wall of the right orbit. A provisional diagnosis of ophthalmoplegia secondary to pressure effect from the mass lesion in the sphenoid sinuses was considered. The patient underwent functional endoscopic sinus surgery (FESS) and fungal debris was removed from the sphenoid and ethmoid sinuses on both sides. Immediate postoperative period, he had improvement in ptosis. On subsequent follow-up, there was a worsening of his symptoms and neurological evaluation done. A repetitive nerve conduction study revealed abnormal decrement in the bilateral median and facial nerves. Blood serum levels showed elevated acetylcholine receptor antibody (10 nmol/L). Thus, a diagnosis of ocular myasthenia gravis was made. The patient was symptomatically better with neostigmine (60 mg) and ophthalmoplegia improved.

  1. Whan Kim S, Woo Kim D, Gyu Kong I, et al. Isolated sphenoid sinus diseases: report of 76 cases. Acta Otolaryngol 2008;128(4):455–459. DOI: 10.1080/00016480701762466.
  2. Patt BS, Manning SC. Blindness resulting from orbital complications of sinusitis. Otolaryngol Head Neck Surg 1991;104(6):789–795. DOI: 10.1177/019459989110400604.
  3. Krisht A, Barnett DW, Barrow DL, et al. The blood supply of the intracavernous cranial nerves: an anatomic study. Neurosurgery 1994;34(2):275–279. DOI: 10.1227/00006123-199402000-00011.
  4. Khattar VS, Hathiram BT, Sharma H. Sternberg's canal and the controversies surrounding it. Otorhinolaryngol Clin 2011;3(3):184–187. DOI: 10.5005/jp-journals-10003-1079.
  5. Luchanok U, Kaminski HJ. Ocular myasthenia: diagnostic and treatment recommendations and the evidence base. Curr Opin Neurol 2008;21(1):8–15. DOI: 10.1097/WCO.0b013e3282f4098e.
  6. Jay WM, Nazarian SM, Underwood DW. Pseudo-internuclear ophthalmoplegia with downshoot in myasthenia gravis. J Clin Neuroophthalmol 1987;7(2):74–76.
  7. Edwards JL, Vincent AM, Cheng HT, et al. Diabetic neuropathy: mechanisms to management. Pharmacol Ther 2008;120(1):1–34. DOI: 10.1016/j.pharmthera.2008.05.005.
  8. Ramsey FM, Smith GD. Clinical use of atracurium in myasthenia gravis: a case report. Can Anaesth Soc J 1985;32(6):642–645. DOI: 10.1007/BF03011412.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.