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TitreHorizontal diplopia and exophtalmos as first signs of trigeminal schwannoma : case report and review of the literature.
Abstract Nr.1072
ButTo present an atypical presentation of trigeminal neurinoma : diplopia and exophtalmos, and review of the literature on the subject.
MéthodesCase report and review of the literature
RésultatsA 21 year-old patient complained of binocular horizontal diplopia for the past 4 years. Examination revealed a left abduction paresis with a 3mm exophthalmos. MRI revealed a voluminous heterogenous tumor in the left middle cranial fossa. Surgical excision was performed and pathology disclosed a trigeminal schwannoma originating in the left gasserian ganglion. Post-operatively, both exophthalmos and left abducens paresis gradually resolved thanks to decreased left cavernous sinus compression and increased orbital outflow.
Literature review revealed that trigeminal schwannoma represents 0.2% of all intracranial tumors. Diplopia is the fourth more common initial symptom behind facial hypesthesia, facial pain and facial paresthesia, none of which were present in our patient. Isolated abducens paresis and exophthalmos is a very rare presentation of trigeminal schwannoma.
ConclusionDiplopia and exophtalmos usually result from an orbital lesion, more rarely from a cavernous sinus process.Trigeminal schwannoma can exceptionally present without any dysfunction of the Vth nerve. An isolated abducens nerve palsy can be caused by a trigeminal schwannoma by compression of the VIth nerve through the cavernous sinus.
It is a benign tumor which can be easily diagnosed by doing an MRI.
There is a treatment and recovery of the VI cranial nerve function is possible.
This entity, even if rare, should be inserted in the differential diagnosis of isolated abducens nerve palsy.
Auteur 1
NomLHOIR
InitialesS
InstitutCHU Saint Pierre
VilleBruxelles
Auteur 2
NomBORRUAT
InitialesF-X
InstitutHôpital Ophtalmique Jules-Gonin
VilleLausanne
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