Posterior rupture of a sphenoid sinus mucocele is a rare cause of brainstem injury.

Case report.

A healthy young woman with a history of prior surgical excision of nasal polyps presented with a headache and evolving neurologic symptoms. The clinical presentation and imaging studies were consistent with a posterior rupture of a large sphenoid mucocele with subsequent inflammatory changes in the brainstem and evidence of brainstem stroke. Relatively rapid recovery coincided temporally with the resolution of local inflammation. Longer-term recovery continued over months, as expected following stroke.

Posterior rupture of a sphenoid sinus mucocele may cause brainstem injury by multiple mechanisms.