Bilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia. Case report

J Neurosurg. 2002 Mar;96(3):600-2. doi: 10.3171/jns.2002.96.3.0600.


The authors report the successful treatment of a 42-year-old man who suffered from recurrent painful ophthalmoplegia caused by bilateral cavernous sinus (CS) actinomycosis. A presumptive diagnosis of Tolosa-Hunt syndrome was made when he presented with left painful ophthalmoplegia. Recurrent ophthalmoplegia on the opposite side when steroid medications were tapered led to repeated imaging and a pterional craniotomy and biopsy sampling of the CS. These tests demonstrated acute inflammation and sulfur granules, which responded clinically and radiologically to parenterally administered penicillin therapy. Actinomycosis may present as a painful ophthalmoplegia with involvement of one or both CSs. Repeated imaging and possibly surgical exploration may be necessary to make a definitive diagnosis.

Publication types

  • Case Reports

MeSH terms

  • Actinomycosis / complications*
  • Actinomycosis / diagnosis
  • Actinomycosis / pathology
  • Adult
  • Biopsy
  • Cavernous Sinus* / pathology
  • Diagnosis, Differential
  • Dominance, Cerebral / physiology*
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Ophthalmoplegia / diagnosis
  • Ophthalmoplegia / etiology*
  • Ophthalmoplegia / pathology
  • Tolosa-Hunt Syndrome / diagnosis
  • Tolosa-Hunt Syndrome / pathology