Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of orbital apex syndrome due to aspergillus infection that avoided loss of visual acuity by optic canal decompression

Kenji Yoshida, M.D.1)3), Akiko Shirata, M.D., Ph.D.1), Taku Sato, M.D., Ph.D.2), Yugo Kishida, M.D., Ph.D.2), Kiyoshi Saito, M.D., Ph.D.2) and Kiyomi Yamane, M.D., Ph.D.1)

1)Department of Neurology, Neurological Institute, Ohta-Atami Hospital
2)Department of Neurosurgery, Fukushima Medical University
3)Present address: Department of Neurology, Fukushima Medical University

A 71-year-old woman was admitted to our hospital complaining of left orbital pain, headache, diplopia and left-sided ptosis, which she had suffered for two months. On examination, the patient had loss of visual acuity, left-sided ptosis, lateral gaze disturbance, and was diagnosed as having left orbital apex syndrome. An abnormal signal to the left orbital cone was detected on MRI. Serum β-D-glucan was increased, and serum Aspergillus antigen and antibody were both positive. Although antifungal drugs (voriconazole and liposomal amphotericin B) were administered, the symptoms deteriorated. The patient then underwent optic nerve decompression surgery and was treated with intravenous methylprednisolone, which gradually improved the patient's symptoms, Aspergillus hyphae were confirmed by pathological examination. To obtain good prognosis for patients with orbital apex syndrome associated with Aspergillus infection, optic nerve decompression surgery should be considered.
Full Text of this Article in Japanese PDF (1515K)

(CLINICA NEUROL, 56: 1|6, 2016)
key words: aspergillus infection, orbital apex syndrome, optic canal decompression

(Received: 29-Jun-15)