Optic Neuropathy and Paratrigeminal Syndrome due to Aspergillus fumigatus

Weinstein, Joel M.; Sattler, Fred A.; Towfighi, Javad; Sassani, Joseph W.; Page, Robert B.

doi:10.1001/archneur.1982.00510210052013

Cited by 17 publications

(7 citation statements)

References 19 publications

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“…In addition, there are two reports of patients in whom no evidence for sinus involvement was found on imaging [1,3]. We present two further cases, which illustrate the particular difficulties that this presents and discuss ways in which the management of this condition could be improved.…”

Section: Introductionmentioning

confidence: 83%

“…Imaging reveals a mass at the orbital apex contiguous with the sinus infection. There are numerous case reports in the literature describing the clinical syndrome [1][2][3][4][5][6][7][8][9]; in the majority of cases the possibility of Aspergillus infection was not considered, quite correctly until other infective causes such as pyogenic organisms and tuberculosis, inflammatory diseases such as sarcoidosis, Wegener's granulomatosis and neoplastic diseases, particularly metastatic carcinoma, had been ruled out.…”

Section: Introductionmentioning

confidence: 99%

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Orbital apex lesion due to Aspergillosis presenting in Immunocompetent patients without apparent sinus disease

2008

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We present two cases in which Aspergillus infection was identified at a late stage in the clinical evaluation as the cause for a painful, progressive and indolent orbital apex syndrome in the absence of any clinical or radiological sign of sinus involvement. Surgical investigation was undertaken with serious subsequent morbidity. Although treatment is often satisfactory, neurological outcome is without exception poor. A review of the literature has revealed that the risk of such investigations is high, and advice is provided to readers which may allow avoidance of such complications in the future.

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Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Orbital apex lesion due to Aspergillosis presenting in Immunocompetent patients without apparent sinus disease

2008

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“…Despite its high nephrotoxicity, amphotericin B is the first-line drug for systemic therapy. In the case of aspergillomata treatment includes aggressive surgical debridement and antifungal therapy with amphotericin B, itraconazole, voriconazole or intracavitary drug administration 2,5,[11][12][13][14] . Despite these efforts mortality remains very high 3,6 .…”

Section: Discussionmentioning

confidence: 99%

“…Aspergillus is a fungus found in soil and organic debris. It commonly presents as a localized disease of the lungs or paranasal sinuses and mainly affects immunocompromised individuals, usually as a fatal opportunistic infection in acquired immunodeficiency syndrome (AIDS) 2,3 . Patients with diabetes, leukemia and lymphoma are at higher risk.…”

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confidence: 99%

Orbital apex syndrome due to aspergillosis: case report

Fernandes

Ramina

Borges

et al. 2001

Arq. Neuro-Psiquiatr.

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We report the case of a 73-year-old female who presented facial numbness and pain in the first division of the trigeminal nerve, ptosis, diplopia and visual loss on the right side for the previous four months. The neurological, radiological and histological examination demonstrated a rare case of invasive fungal aspergillosis of the central nervous system, causing orbital apex syndrome, later transformed in temporal brain abscess. She died ten months later due to respiratory and renal failure in spite of specific antimycotic therapy.KEY WORDS: aspergillosis, orbital apex syndrome, mycoses, brain abscess.Síndrome do ápice da órbita causada por aspergilose: relato de caso RESUMO Relatamos o caso de mulher de 73 anos de idade que apresentou nos últimos 4 meses amortecimento facial, dor no território do primeiro ramo do nervo trigêmeo, ptose palpebral, diplopia e perda da acuidade visual, à direita. A investigação neurológica, radiológica e histológica demonstrou se tratar de uma lesão no ápice da órbita de origem fúngica, aspergilose com transformação tardia em abscesso cerebral. A paciente faleceu 10 meses após o tratamento inicial embora tenha sido tratada com medicação antifúngica específica. PALAVRAS-CHAVE: aspergilose, síndrome do ápex da órbita, micose, abscesso cerebral.

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“…Non-invasive aspergillosis remains localized in the sinuses, whereas invasive aspergillosis is associated with ulceration and destruction of the sinus, as well as hematogenous spread [1,2]. When the infection spreads beyond the sphenoid sinus, it can lead to orbital apex syndrome, compressive optic neuropathy, or optic neuritis due to its geographic proximity to the optic nerve [3-5]. Here, we report a case of indolent invasive aspergillosis presenting as a junctional scotoma.…”

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confidence: 99%

A Congruous Superior Quadrantanopsia Following a Junctional Scotoma Induced by Asperogillosis

Park

Lee

Chun

2011

Korean J Ophthalmol

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A 69-year old man presented to us with decreased vision in his right eye and a relative afferent pupillary defect. Under the presumption that he was suffering from retrobulbar optic neuritis or ischemic optic neuropathy, visual field tests were performed, revealing the presence of a junctional scotoma. Imaging studies revealed tumorous lesions extending from the sphenoid sinus at the right superior orbital fissure, with erosion of the right medial orbital wall and optic canal. Right optic nerve decompression was performed via an endoscopic sphenoidectomy, and histopathologic examination confirmed the presence of aspergillosis. The patient did not receive any postoperative antifungal treatment; however, his vision improved to 20 / 40, and his visual field developed a left congruous superior quadrantanopsia 18 months postoperatively. A junctional scotoma can be caused by aspergillosis, demonstrating the importance of examining the asymptomatic eye when a patient is experiencing a loss of vision in one eye. Furthermore, damage to the distal optic nerve adjacent to the proximal optic chiasm can induce unusual congruous superior quadrantanopsia.

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Optic Neuropathy and Paratrigeminal Syndrome due to Aspergillus fumigatus

Cited by 17 publications

References 19 publications

Orbital apex lesion due to Aspergillosis presenting in Immunocompetent patients without apparent sinus disease

Orbital apex lesion due to Aspergillosis presenting in Immunocompetent patients without apparent sinus disease

Orbital apex syndrome due to aspergillosis: case report

A Congruous Superior Quadrantanopsia Following a Junctional Scotoma Induced by Asperogillosis

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