Bilateral diplopia and abducent nerve palsy secondary to odontogenic sinusitis : an unusual presentation

Abstract EN

We present a patient with double vision, photophobia, headache and gait disturbance secondary to odontogenic sinusitis.

The initial diagnosis was meningitis; the patient had bilateral diplopia, severe unilateral facial pain, nasal blockage, photophobia, headache and gait disturbance.

The Patient underwent a septic screening and CT scan of the nose and paranasal sinuses which confirmed unilateral pan-sinusitis.

MRI revealed enhancement of bilateral abducent nerves secondary to irritation of the meninges by the opacified sphenoid sinus.

The abducent nerve is the first cranial nerve to be affected when the dura is inflamed leading to bilateral diplopia.

This unusual presentation led to the initial diagnosis of arachnoiditis.

Patient underwent a unilateral full endoscopic sinus surgery and dental extraction of the affected tooth and had a full recovery with intravenous antibiotics and intravenous steroids.