Primary melanoma of the sphenoid sinus presenting with a third cranial nerve palsy.

Abstract

An 83-year-old woman presented with right trigeminal paresthesias, upper lid ptosis, and diplopia and was found to have a right third cranial nerve palsy. MRI disclosed a right sphenocavernous mass with speckled high signal on pre-contrast T1 and correspondingly low signal on T2. Endoscopic sphenoidotomy revealed malignant melanoma. The patient underwent radiation therapy with complete and protracted resolution of the palsy. An extensive evaluation for a primary source was negative. The combination of high T1 signal and low T2 signal in a mass should suggest melanin. An exceedingly rare condition, this is the first English report of its presentation with a third cranial nerve palsy.

• Authors: Shannon C Lynch, Andrew G Lee, Scott M Graham, Patricia A Kirby
• Journal: Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society (J Neuroophthalmol) Vol. 25 Issue 4 Pg. 289-92 (Dec 2005) ISSN: 1070-8022 [Print] United States
• PMID: 16340495 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged, 80 and over
• Blepharoptosis (diagnosis)
• Diplopia (diagnosis)
• Female
• Humans
• Magnetic Resonance Imaging
• Melanoma (pathology)
• Oculomotor Nerve Diseases (diagnosis)
• Paranasal Sinus Neoplasms (pathology)
• Sphenoid Sinus (pathology)
• Tomography, X-Ray Computed