Optic Neuropathy, Secondary to Ethmoiditis, and Onodi Cell Inflammation during Childhood: A Case Report and Review of the Literature

Abstract

Optic neuropathy consists of several etiological events. The primary etiologies of its acute form include optic neuritis, ischemic optic neuropathy, inflammatory (nondemyelinating) disorders, and trauma. Its subacute and chronic forms are most often linked to compressive, toxic, nutritional, or hereditary-genetic causes. Visual loss, dyschromatopsia, and visual field defects are the presenting symptoms. The Onodi cell (sphenoethmoidal air cell) is an anatomic variant located laterally and superior to the sphenoid sinus; it is closely related to the optic nerve. Onodi cell disorders are rare and may be unnoticed in differential diagnoses of patients with ocular and neurological manifestations. Here, we present the case of a 12-year-old boy with headache and acute loss of sight characterized by hemianopsia in the left eye and retrobulbar optic neuropathy caused by left sphenoethmoidal sinusitis with the presence of Onodi cell inflammation. The diagnosis was confirmed by multilayered paranasal computed tomography and cerebral magnetic resonance imaging. Therapeutic treatment resulted in gradual improvement: at the 2-week follow-up, the patient no longer had headaches and his visual acuity returned to normal. Inflammation of Onodi cells should be considered in children with headache and abnormal vision.

Three-dimensional volumetric investigation of Onodi cells: a multi-slice computer tomography study

“…Results from earlier studies [11,9,[12][13][14] indicated that there is an equal distribution between genders for anatomic variation of OCs. Our study is in agreement with these results, as we found no statistically signi cant association between cell volume and gender for unilateral and bilateral groups.…”

“…In a recent article[8], it was reported that OCs can have a high variability of prevalence, ranging from 1.6 to 55.8%. We can assume that the high prevalence may be associated with the fact that several different devices can be used to acquire the images, such as CT [12], cone beam CT [3] and magnetic resonance imaging [9]. These devices present different types of visualization precision.…”

“…Chmielik et al [14] demonstrated that the wall of the optic nerve canal was in contact with at least one posterior ethmoid cell (55.6%). In the studies by Mazzurco et al [9] [13] and Lee et al [15], they reported two patients who had optic neuropathy and temporary visual loss due to the presence of OC in ammation, thus highlighting the importance of knowing the proximity of OC to neighboring anatomic structures. However, our study contrasts with their ndings as we observed no statistically signi cant association between OC volume and contact with optic nerve for unilateral and bilateral groups.…”

“…A radiologist with experience in MSCT imaging identi ed and segmented all the OCs independently, in which a semi-automatic method was used by making the active contour evolving towards the target object to de ne the region of interest (ROI) and threshold based on air bubbles inside the OCs, which were identi ed as the lateral extension of posterior ethmoid cells [9]. The left and right maxillary sinuses were marked with different colors for calculating the volumes separately.…”

Posterior ischemic optic neuropathy following supine craniotomy for epidural abscess in a child

“…AION has also been reported after cranial vault surgery as well [13]. Sinusitis or infection may predispose to vascular injury with unclear mechanisms [14][15][16]. Aldrees et al reported a case of bilateral PION in the context of methicillin-resistant staph aureus bacteremia [17].…”