The Diagnostic Challenge of Distinguishing Temporal Lobe Encephaloceles from Sphenoid Sinus Mucoceles

Abstract

Temporal lobe encephaloceles are rare malformations defined as brain parenchyma herniation through a skull base structural defect into adjacent structure such as sphenoid sinus, while sphenoid sinus mucoceles are expansive cystic lesions caused by mucus buildup and thinning of the sinus wall, mostly involving the frontal and ethmoid sinus. Both illnesses may present similar clinical symptoms, such as neurological symptoms, nasal and ophthalmologic symptoms. However, misdiagnosis of temporal lobe encephaloceles can have significant clinical implications, as the best treatment plans vary depending on the disease. A 27-year-old healthy man who presented with seizure and loss of consciousness in public gave a history of head trauma 13 years back. Upon physical examination, the patient had normal cranial nerve function, and no cerebellar or meningitis signs. Rigid nasoendoscopy showed unremarkable findings. A computed tomography scan revealed an expanded left sphenoid sinus likely mucocele with a left temporal lobe encephalomalacia. Further investigations with brain magnetic resonance imaging (MRI) discovered temporal lobe encephalocele and transcranial repair of sphenoid encephalocele was arranged. Imaging results interpreted incorrectly may result in significant clinical ramifications. Distinguishing between both diseases with a complete investigation including MRI scan is crucial for appropriate management and treatment planning.