Isolated Sphenoid Sinus Infection with Polyneuritis Cranialis Masquerading as Migraine!

Vinod M1,2*, Neha M2, Dania A2, George K2, Roberto P2, Zeeshan K2, Hasna H2, Chaudhuri KR1,2 and Chung-Faye G1,2

1Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson’s Foundation Centre of Excellence, King’s College London, King’s College Hospital, UK 2Parkinson’s Foundation Centre of Excellence, King’s College Hospital London, Dubai, UAE

^*Correspondance to: Vinod Metta 

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Abstract:

Background: Headache is one the commonest presentation in primary care settings especially preceding with any viral illness often poses a challenge to the treating physician perhaps a validated screening tool highlighting red flags increase the chance of predicting underlying etiology aids prompt diagnosis and management. Case Report: A 40-year-old Emirati mother of four with no previous personal or family medical history of migraines, presented to local General Practitioner (GP) with a 4-month history of on and off headaches followed by mild flu like illness apart from mild runny nose no other obvious Sino nasal or cranial autonomic symptoms. A month after onset of the headaches, the patient began to notice a slight change in intensity with a worsening pattern, especially on exertion and bending. On examination, the patient was conscious and fully oriented. Cranial nerve examination showed normal visual acuities, right papilledema, reduced right afferent corneal reflex, with normal extraocular eye movements. no other signs of meningeal irritation were present, MRI of the brain and orbits showed mucosal thickening and enlargement of both right and left sphenoid sinus, right worse than the left with extension to the cavernous sinus. Trans nasal endoscopy showed a bilateral congested sphenoid sinus with purulent discharge, which was drained off and treated with IV Ceftriaxone and dexamethasone and the patient had dramatic clinical improvement. Conclusion: Any headache associated with peri-orbital pain or retro-orbital pain associated with exertional element, requires thorough neurological examination, and warrants urgent appropriate investigations and specialist attention.

Keywords:

Migraine with aura; Cavernous Sinus thrombosis; Sphenoid sinus; Retro-orbital pain; Afferent corneal reflex; Polyneuritis cranialis

Cite the Article:

Vinod M, Neha M, Dania A, George K, Roberto P, Zeeshan K, et al. Isolated Sphenoid Sinus Infection with Polyneuritis Cranialis Masquerading as Migraine!. Ann Clin Case Rep. 2024; 9: 2615.