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Images in Neurology |

Diplopia Due to Frontal Sinus Mucocele

Juliana Lockman, MD; Ivan S. Login, MD
Arch Neurol. 2007;64(11):1667-1668. doi:10.1001/archneur.64.11.1667.
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A 63-year-old man presented with a 5-month history of diplopia, described variably as horizontal, vertical, or skewed. This complaint appeared in the setting of anosmia for 4 years and right ptosis for 2 years. Results of physical examination showed mild right hypophthalmos, right proptosis, and fusion deficits in all cardinal fields of gaze on Maddox rod testing. Computed tomographic and magnetic resonance imaging revealed a large right frontal sinus mucocele with erosion inferiorly into the orbit, displacing the globe laterally and impinging on the superior and medial rectus muscles (Figure). The mucocele extended posteriorly into the right frontal lobe. There was also evidence of a pansinus inflammatory process with polypoidal thickening. The diplopia seen in this patient was due to mass effect in the orbit. His chronic anosmia was a clue to the possibility of mucocele as an etiology. After successful surgical intervention, the patient continues to remain asymptomatic.

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A, Unenhanced coronal computed tomographic scan. The mucocele has rarefied the supramedial bony orbital wall (asterisk) to invade the orbit. B, Gadolinium-enhanced T1-weighted fat-saturated coronal magnetic resonance imaging. A peripherally enhancing hypointense right frontal mucocele, extending posteriorly into the frontal fossa (long arrow) and inferiorly into the orbit (short arrow), laterally displacing the globe is seen. Also note extension of the mucocele into the upper nasal cavity with pansinus fluid and polypoidal thickening.

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