Bilateral visual loss and paraplegy in a patient with metastaic carcinoma of stomach

Abstract

Purpose We present a case report of bilateral visual loss and paraplegy in patient with metastatic carcinoma of stomach. Methods 64‐year old male presented with painless visual loss on right eye, and one week later, he was blind on both eyes with no light perception and amaurotic pupils. One year earlier he was diagnosed with primary metastatic carcinoma of stomach and was treated by Xeloda and Docetaxel. Fundi revealed bilateral hyperemic disc oedema. Solu‐Medrol 1 g i.v. for three days had no effect. Results CT and MRI of brain showed no lesion that would explain his visual loss. Scotopic and photopic electroretinography was normal.Visual evoked potentials (VEP) on flash stimulation were nonrecordable. Specific onco‐neurologic antibodies in CSF and serum were negative:anti‐Ri(ANNA‐2),anti‐Yo,anti‐CV2(CRMP5),anti‐amphiphysin,anti‐Mal,anti‐Hu(ANNA‐1),anti‐Ma2(Ta‐). One month after onset of blindness, he had acute neurological deterioration with paresis of left leg and retention of urine which was diagnosed as Brown‐Sequard syndrome. MRI of spinal chord showed intramedular lesion between Th 6‐10. Oligoclonal bands in serum and CSF were identical, indicating systemic inflammation. Serum was sent for testing NMO‐IgG,but results are in process. Patient was restarted on high doses of Solu‐Medrol i.v. Slight improvement of vision was noted after few days of therapy, and flash‐evoked VEP was barely detectable. The discs were no longer swollen and appeared pale. Conclusion This unusual case of bilateral blindness due to optic neuropathy might be linked to atypical presentation of neuromyelitis optica or to paraneoplastic optic neuropathy caused by yet unknown antigen.