An unusual presentation of a giant frontal mucocoele manifesting with frontal lobe syndrome.

Dear Editor, Mucocoeles develop from paranasal sinuses. They are epithelium-lined, mucus containing lesions and present as slowly enlarging masses. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid and maxillary mucocoeles are rare.1 Accumulation of mucus secretion, generally, is caused by paranasal sinus infl ammation, fi brosis, trauma, previous surgery, anatomical abnormality, or mass lesion such as osteoma. Mucocoeles can spread both intraorbitally and intracranially.2,3 Frontal lobe syndrome (FLS) was fi rst defi ned in 1868 by Harlow.4 FLS is a pattern of signs and symptoms associated with the damage of the frontal lobe.5 Typically, FLS includes general impairment of planning functions, boastfulness, lack of inhibition, hypomanic episodes, impulsiveness, anti-social behaviour, depression, apathy and perseveration.4 Manifestations of a frontal lobe syndrome depend on many factors: patient’s baseline intelligence, education, site of lesions, age, sex and function of non-frontal brain regions.4 Causes of FLS include mental retardation, cerebrovascular disease, head trauma, brain tumours compressing the frontal lobe parenchyma, brain infections, neurodegenerative diseases and normal pressure hydrocephalus.4,5 A 68-year-old male complained of a worsening headache for 3 to 4 weeks prior to admission. He had diplopia for 1 to 2 months. Proptosis, periorbital swelling and exophthalmus were other fi ndings. There was no history of surgery or trauma. His relatives stated that he had personality and behavioural alterations recently. The patient complained of memory disturbances including inability to recall longknown and major details such as his own address, perception diffi culties and impaired long and short-time memory. Neurological examination revealed unilateral papilledema in fundoscopy. Ocular movements were limited at the right side. Memory evaluation tests were performed (Wechsler Memory Scale-Revised test). Verbal and visual memory scores were low. These fi ndings supported that his behaviour alterations were due to memory dysfunction. Thyroid function tests, white blood cell count, C-reactive protein and B-12 levels were normal and serology for syphilis, tests for HIV or connective tissue disorders were negative. Laboratory examinations did not suggest infection or another systemic disease like thyrotoxicosis. Radiological imaging using computed tomography (CT) An Unusual Presentation of a Giant Frontal Mucocoele Manifesting with Frontal Lobe Syndrome