Abstract
IntroductionCranial nerve palsy is a common presentation in the neuro-ophthalmology clinic and investigations are directed towards the cause. Metastatic breast cancer presenting as carcinomatous meningitis leading to sequential fourth, third and sixth nerve palsy is very rare. This is the first case to be reported to the best of our knowledge.Case presentationA 66-year-old Caucasian woman presented with vertical double vision for the previous 3 weeks. At 6-weeks follow up this had resolved. However, she presented with a new third and sixth cranial nerve palsy. Neuroimaging with contrast revealed carcinomatous meningitis.ConclusionsMetastatic cancer may manifest as cerebral metastases or carcinomatous meningitis. This is evident on neuroimaging with contrast and may be missed on unenhanced scans.
Highlights
Cranial nerve palsy is a common presentation in the neuro-ophthalmology clinic and investigations are directed towards the cause
Carcinomatous meningitis has been reported in 5% of breast cancers and can present with headache, cranial nerve dysfunction, seizures and intracranial hypertension signals [1]
Prognosis is poor and treatment options limited [2,3]. It results from metastatic infiltration of the leptomeninges by malignant cells leading to central nervous system dysfunction [4]
Summary
Carcinomatous meningitis has been reported in 5% of breast cancers and can present with headache, cranial nerve dysfunction, seizures and intracranial hypertension signals [1]. The case described here is rare because carcinomatous meningitis manifested as cranial nerve palsy in a woman without a known history of breast cancer. A clinical examination showed right fourth cranial nerve palsy. Her magnetic resonance imaging (MRI) scan was. Case is rare because the patient presented with fourth cranial nerve palsy as the first manifestation of undiagnosed metastatic breast malignancy. Subsequent involvement of other cranial nerves causing ophthalmoplegia pointed to a more sinister condition By this time she had biopsy proven breast cancer. Palliative hormone therapy was commenced for metastatic breast cancer She responded quickly with complete resolution of diplopia, ptosis and numbness on her right anterior scalp within 8 weeks of starting anastrozole
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