Metastatic Prostate Cancer Manifesting as Cavernous Sinus Syndrome—Case Report and Review of the Literature

Abstract

Cavernous sinus syndrome (CSS) is a rare clinical entity which results in compression of the neurovascular structures in the cavernous sinus, potentially leading to headache, ophthalmoplegia, and neuropathy. The most common causes are tumor, trauma, inflammation, aneurysm, and infection. We report the case of an 82-year-old male with osseous-predominant metastatic prostate cancer who was admitted for intractable right-sided periorbital pain and diplopia. He also developed a headache with associated mild ptosis and weak cranial nerve (CN) VI function. He later developed complete right eye ptosis, complete CN VI paralysis, and palsies of CNs III and IV. Magnetic resonance imaging (MRI) of the sella turcica confirmed a distinct enhancing lesion in the cavernous sinus and he was diagnosed with CSS as a result of bony metastasis from his prostate cancer. He was started on high-dose steroids, and underwent directed radiation therapy. Bone metastasis is common with prostate cancer with predilection for more proximal structures such as the iliac bones and lumbar spine. Cases of CSS stemming from metastatic prostate cancer are rare. Thus, the development of CN palsy and ophthalmoplegia along with orbital pain should trigger a thorough investigation of the etiology of CSS which should include primary malignancies and metastasis from more distant structures such as the prostate.