# The Riddle of the Double Vision—A Rare Case of Intracranial Tumor: When Imaging Resolves the Mystery

## TL;DR

A 77-year-old man with double vision was diagnosed with a rare intracranial tumor originating from the maxillary sinus.

## Contribution

This case highlights the diagnostic value of urgent MRI in identifying rare intracranial tumor spread from sinonasal origin.

## Key findings

- MRI revealed a tumor originating from the left maxillary sinus with intracranial spread.
- Biopsy confirmed sinonasal squamous cell carcinoma involving cranial nerves and sinuses.
- The patient exhibited III and VI cranial nerve paralysis with ptosis and eye movement deficits.

## Abstract

A 77-year-old-man with arterial hypertension, diabetes mellitus type II presented at our clinic for a routine ophthalmological exam. He complained of intermittent double vision. The ophthalmic examination revealed paralysis of III (n. oculomotorius) and VI (n. abducens) cranial nerves with ptosis, deficit in elevation and abduction of the left eye. The patient underwent urgent MRI imaging of the brain/orbits and paranasal sinuses, and urgent neurological assessment. MRI revealed a volume-occupying process, starting from the posterior wall of the left maxillary sinus with perineural diffusion and involvement of the homolateral trigeminal nerve, intracranial spread in the medial cranial fossa and involvement of the cavernous, sphenoidal sinuses and the orbital apex on the left side. Biopsy was performed, and the histology resulted in sinonasal squamous cell carcinoma with intracranial spread.