Bilateral Visual Loss Caused by Pneumosinus Dilatans: Idiopathic Cases are not Always Reversible

PURPOSE: To report a rare case of primary pneumosinus dilatans (PSD) and to specify the cardinal imaging findings associated with this condition. METHODS: A 20-year-old patient presented with bilateral profound visual loss as a result of primary PSD. A detailed review of clinical findings and presumed pathophysiological basis of vision loss was performed. RESULTS: Other than undiagnosed primary hypothyroidism, no other abnormalities were found. With the diagnosis of PSD, the patient underwent optic nerve decompression through transnasal sphenoidotomy. However, after nine months of follow-up, no improvement in the patient's vision was attained. CONCLUSION: Unlike previous reports of favorable visual results after sphenoidotomy and bilateral decompression of the optic nerves, vision recovery was not achieved in this case.