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Chai C, Feng X, Li K, Yan Z, Tan S, Weng J, Huang F, Huang J, Zhu X, Zhuo X, Chen H. Paranasal sinus angiosarcoma with facial paralysis as a novel manifestation: a case report and literature review. BMC Neurol 2023; 23:428. [PMID: 38042771 PMCID: PMC10693057 DOI: 10.1186/s12883-023-03482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Paranasal sinus angiosarcoma is an uncommon malignancy, with only a few reported cases worldwide. Although it exhibits multiple symptoms, facial paralysis has not been previously documented as a noticeable presentation. CASE PRESENTATION In this case, we report a 40-year-old male who presented with facial numbness and pain for one month, weakness of his facial muscles for 15 days, and recurrent right epistaxis for 1 year. He had a history of nasal inflammatory polyps with chronic sinusitis. Computed tomography and magnetic resonance imaging showed space-occupying lesions in the right nasal cavity and maxillary sinus, with bone destruction occurring in the sinus wall and turbinate. This patient then underwent endoscopic surgery. According to the histopathological and immunohistochemical results, he was eventually diagnosed with paranasal sinus angiosarcoma in April 2021. To date, this patient has not initiated any radiotherapy or chemotherapy and has survived with lymphatic metastasis for at least 3 years. CONCLUSIONS This manuscript suggests that paranasal sinus angiosarcoma can present with facial paralysis. Moreover, pathological and immunohistochemical tests are still vital for diagnosing paranasal sinus angiosarcoma and differential diagnosis. Additionally, regular follow-up is crucial for patients with paranasal sinus angiosarcoma, enabling monitoring of recurrence, metastasis, and recovery while contributing valuable clinical data to understanding this rare disease and associated research endeavours.
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Affiliation(s)
- Chengcheng Chai
- The Second Clinical College, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou, Guangdong, 510405, China
| | - Xiaocong Feng
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China
| | - Kai Li
- The Second Clinical College, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou, Guangdong, 510405, China.
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China.
| | - Zhaoxian Yan
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China
| | - Shuyi Tan
- The Second Clinical College, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou, Guangdong, 510405, China
| | - Jin Weng
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China
| | - Fan Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Room No. ST512, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| | - Jianpeng Huang
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China
| | - Xinru Zhu
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China
| | - Xuehui Zhuo
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China
| | - Hai Chen
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou, Guangdong, 510120, China.
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Gupta N, Dembla S. Cranial nerve involvement in mucormycosis in post-COVID patients: a case series. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC8785391 DOI: 10.1186/s43055-022-00700-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background One of the largest outbreaks of rhinosinocerebral mucormycosis (RSCM) occurred in India close to the second wave of the SARS-CoV-2 infection. RSCM is a rare infection caused by several fungal species occurring in immunocompromised subjects. Mucor shows a high propensity to invade the central nervous system. There have been limited studies, mostly isolated case reports, on the neurological manifestations of RSCM. The outbreak of mucormycosis infection was thus the most opportune to study the neurological manifestations and cranial nerve involvement in mucormycosis in greater depths.
Aim of the study The purpose of the study was to investigate and review the involvement of cranial nerves in a series of cases of rhinosinocerebral mucormycosis associated with the novel coronavirus disease caused by SARS-CoV-2. Results It was a retrospective cross-sectional study of seven patients who were undergoing treatment of RSCM with a recent history of coronavirus disease caused by SARS-CoV-2 infection within the last 3 months. Patients with cranial nerve involvement were identified by magnetic resonance imaging (MRI) at a single institution. Demographic details of the patients, clinical presentation, imaging, microbiological and pathological findings were recorded. All subjects had two or more cranial nerves affected by fungal infection. The most commonly involved cranial nerve was found to be the optic nerve followed by the trigeminal nerve and its branches. We document three cases with extensive involvement of the inferior alveolar branch of the mandibular division of the trigeminal nerve (V3), a previously unreported finding. In one case, in addition to the second and fifth cranial nerves, the third, fourth, sixth, seventh, eighth, and twelfth cranial nerves were involved without any sensory or motor long tract involvement, suggestive of Garcin syndrome secondary to intracranial abscesses and skull base osteomyelitis due to invasive fungal infection. This case is of rare occurrence in the literature, and our study provides one such example. Conclusion Cranial nerve involvement in patients of mucormycosis tends to have a poor prognosis, both cosmetic and functional. Radical surgeries and aggressive medical management is needed in such cases to improve the outcome.
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Wang C, Zhang X, Yang Y, Wan D. Secondary hemicrania continua-tic syndrome associated with fungal sphenoiditis: A case report. Clin Case Rep 2021; 9:e04297. [PMID: 34026209 PMCID: PMC8133077 DOI: 10.1002/ccr3.4297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
The coexistence of hemicrania-continua and trigeminal neuralgia is called HC-tic syndrome. We describe a case of an elderly man who suffered both types of headache related to fungal sphenoiditis. This is the first case to be reported, to the best of our knowledge.
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Affiliation(s)
- Chunyu Wang
- Department of NeurologyThe 940th Hospital of Chinese PLALanzhouChina
- Department of EndocrineThe 940th Hospital of Chinese PLALanzhouChina
| | - Xiaoyan Zhang
- Department of NeurologyThe 940th Hospital of Chinese PLALanzhouChina
| | - Yanli Yang
- Department of PathologyThe 940th Hospital of Chinese PLALanzhouChina
| | - Dongjun Wan
- Department of NeurologyThe 940th Hospital of Chinese PLALanzhouChina
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Nomura K, Ryu H, Nishizawa S, Yoshimi R, Oida I. Trigeminal Neuralgia from Acute Sphenoid Sinusitis: Consideration of Anatomical Sphenoid Sinus Variation - A Case Report. Case Rep Neurol 2021; 13:171-178. [PMID: 33790776 PMCID: PMC7989944 DOI: 10.1159/000513684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/08/2020] [Indexed: 11/19/2022] Open
Abstract
Although the etiology of classical trigeminal neuralgia is clearly understood to be neurovascular compression, the exact etiology of trigeminal neuralgia with continuous pain is often unknown. Mild sphenoid sinusitis is not usually considered to induce trigeminal neuralgia, especially when limited to the maxillary nerve. We report a rare case of trigeminal neuralgia of the maxillary nerve caused only by mild sphenoid sinusitis and discuss the significance of the anatomical structure and diagnostic procedures. A 45-year-old woman noticed a sudden onset of temporal pain followed by numbness on her right cheek. Her right gingiva also experienced sensory disturbance. The symptoms gradually subsided after the initial onset, but they persisted. She visited our hospital for further examinations and had no febrile episodes throughout the course. A tingling sensation and sensory disturbance were only identified in the maxillary nerve. No other neurological symptoms were noted. Magnetic resonance imaging revealed mild sphenoid sinusitis on the right side. The absence of the bony boundary between the sphenoid sinus and maxillary nerve was revealed using thin-sliced computed tomography (CT). The patient's symptoms were diagnosed as maxillary neuropathy caused by mild sinusitis. The bony defect around the maxillary nerve was considered to have affected development of the pathological process. Even mild sphenoid sinusitis can cause inflammation to spread to the maxillary nerve if no bony boundary exists between it and the sphenoid sinus. A coronal CT study is highly beneficial for clarifying the pathophysiological mechanism of trigeminal neuralgia limited to the maxillary nerve.
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Affiliation(s)
- Kei Nomura
- Center for Brain and Spine Surgery, Aoyama General Hospital, Toyokawa, Japan
| | - Hiroshi Ryu
- Center for Brain and Spine Surgery, Aoyama General Hospital, Toyokawa, Japan
| | - Shigeru Nishizawa
- Department of Neurosurgery, Suzukake Central Hospital, Hamamatsu, Japan
| | - Ryoko Yoshimi
- Department of Dentistry and Oral Surgery, Aoyama General Hospital, Toyokawa, Japan
| | - Izumi Oida
- Department of Otolaryngology, Aoyama General Hospital, Toyokawa, Japan
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Tashi S, Purohit BS, Becker M, Mundada P. The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited. Insights Imaging 2016; 7:589-99. [PMID: 27230518 PMCID: PMC4956626 DOI: 10.1007/s13244-016-0498-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/25/2016] [Accepted: 05/03/2016] [Indexed: 01/17/2023] Open
Abstract
Abstract The pterygopalatine fossa (PPF) is a small, clinically inaccessible, fat-filled space located in the deep face that serves as a major neurovascular crossroad between the oral cavity, nasal cavity, nasopharynx, orbit, masticator space, and the middle cranial fossa. Due to its inherent complex location and connections, it can potentially act as a natural conduit for the spread of inflammatory and neoplastic diseases across the various deep spaces in the head and neck. This review aims to acquaint the reader with the imaging anatomy of the PPF, its important communications, and to identify some major pathological conditions that can involve the PPF, especially in conditions where its involvement can have serious diagnostic and therapeutic implications, such as in perineural tumour spread. Teaching points • The PPF is a small neurovascular junction in the deep face with important to-and-fro connections. • Awareness of anatomy of the PPF and its communications helps to simplify imaging of its pathology. • Perineural tumour spread is clinically the most important pathology in this region.
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Affiliation(s)
- Sonam Tashi
- Department of Diagnostic Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Bela S Purohit
- Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Minerva Becker
- Department of Imaging, Division of Radiology, Geneva University Hospital, Rue Gabrielle Perret Gentil 4, 1211, Geneva 14, Switzerland
| | - Pravin Mundada
- Department of Diagnostic Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
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