Alternating orbital symptoms in cavernous sinus syndrome due to isolated sphenoid sinusitis.

A 40-year-old male with left-sided headaches, ptosis, proptosis and extra-ocular muscle paralysis developed right-sided headaches, proptosis, chemosis, diplopia, extra-ocular muscle paralysis and trigeminal sensory loss. An enhancing left orbital, intrasellar and parasellar cavernous nodule on magnetic resonance imaging progressed into a right cavernous sinus and orbital apex soft tissue mass. Cavernous sinus syndrome from sphenoid sinusitis resolved after endoscopic transnasal sphenoidotomy. This diagnostic complexity and its treatment options are discussed according to current literature.