Thread by @guerreroespejo

A 59-YO DM, steroid, myasthenia gravis with thymoma: headache & deviation of tongue to the R side with fasciculation suggestive of right 12th cranial nerve palsy

CT: sphenoid sclerotic changes, soft tissue density lesion with calcification.
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#neurology #radiology #IDtwitter

MRI brain: a hypointense lesion involving the body of sphenoid (R > L) and clivus on T2 weighted images and T1 weighted images with moderate contrast enhancement possibly fungal in aetiology.
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doi.org/10.1016/j.idcr…
#radiologist #radres #MedTwitter

Endoscopic sphenoidotomy & debridement: invasive fungal sphenoid sinusitis & CENTRAL SKULL BASE OSTEOMYELITIS involving the clivus

🔬from sphenoid mucosa: morphologically ASPERGILLUS with foci of tissue invasion.
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#microbiology #maxillofacial #Orthopedics

CENTRAL SKULL BASE OSTEOMYELITIS SECONDARY TO INVASIVE ASPERGILLUS SPHENOID SINUSITIS PRESENTING WITH ISOLATED 12TH NERVE PALSY

Oral voriconazole for 10 weeks: On follow-up, symptomatically better, with improvement in 12th cranial nerve palsy.
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#Doctor #MedStudentTwitter

Skull base osteomyelitis is a potentially life-threatening infection, usually seen in elderly immunocompromised patients secondary to malignant otitis externa (MOE) caused by Pseudomonas.
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#MedicalStudents #MedEd

Here this case of skull base osteomyelitis occurred as a complication of sphenoid sinusitis rather than malignat otitis media, caused by invasive Aspergillus infection, with isolated hypoglossal nerve palsy.
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#mycology #resident #medicine

In skull base osteomyelitis cases most patients present with pain & cranial nerve involvement with no obvious infectious source & thereby giving a high suspicion of malignancy.

The crux of management lies in the🔬diagnosis as the imaging findings frequently mimic malignancy
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Central skull base osteomyelitis is a:
📌rare,
📌life threatening condition

and that secondary to invasive aspergillosis presenting with isolated hypoglossal nerve palsy is
📍extremely rare.

#neurology #radiology #IDtwitter