Isolated clival metastasis as the cause of abducens nerve palsy in a patient of breast carcinoma: A rare case report

Kapoor, Akhil; Beniwal, Vimla; Beniwal, Surender; Mathur, Harsh; Kumar, Harvindra Singh

doi:10.4103/0301-4738.158096

Cited by 13 publications

(3 citation statements)

References 12 publications

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“…While paralysis of the fifth nerve can lead to hypoesthesia of the portions of the face depended to the location of involvement. Interestingly, our patient developed an isolated sixth nerve palsy, as an unusual neuroophthalmic presentation for this tumor [5,6]. She had upward growth of the tumor into the middle cranial fossa with engagement of the clivus, that led to right sixth neve palsy with the presentation of abduction deficit of the right eye with occasionally horizontal diplopia.…”

Section: Discussionmentioning

confidence: 73%

Isolated unilateral sixth nerve palsy in a patient with nasopharyngeal carcinoma

Aghdam¹,

Zand²,

Sanjari³

2019

rjo

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Objective: To describe an isolated unilateral sixth nerve palsy, as a rare neuroophthalmic presentation of nasopharyngeal carcinoma. Methods: We report a 54-year-old female, known case of nasopharyngeal carcinoma who was treated with chemo-radiotherapy, and presented with isolated right sixth nerve palsy. Magnetic resonance imaging (MRI) indicated extension of tumor to intracranial fossa with clival involvement. Results: The patient was referred to an otolaryngologist for further evaluation and necessary intervention due to invasion of the cancer to intracranial fossa with involvement of right abducens nerve. Conclusions: Although, isolated sixth nerve palsies in adults over the age of 50 are usually ischemic; but in enduring cases, neoplastic processes should be considered.

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Section: Discussionmentioning

confidence: 73%

Isolated unilateral sixth nerve palsy in a patient with nasopharyngeal carcinoma

Aghdam¹,

Zand²,

Sanjari³

2019

rjo

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“…It then arrives at the cavernous sinus where it is contiguous and medial with and to the internal carotid artery, respectively. It then arrives at the orbit via the superior orbital fissure [ 9 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit

Okudo

Anusim

2016

Case Reports in Neurological Medicine

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Renal cell carcinoma (RCC) has unusual presentation affecting elderly males with a smoking history. The incidence of RCC varies while the incidence of spread of RCC to the clivus is rare. The typicality of RCC presentation includes hematuria, flank pain, and a palpable flank mass; however, RCC can also present with clival metastasis. The unique path of the abducens nerve in the clivus makes it susceptible to damage in metastasis. We report a case of a 54-year-old African American female that was evaluated for back pain, weakness, numbness, and tingling of bilateral lower extremities and subsequently disconjugate gaze and diplopia. Brain MRI confirmed metastasis to the clivus. She was started on radiotherapy and was planned for chemotherapy and transfer to a nursing home. When a patient presents with sudden unusual cranial nerve pathology, the possibility of metastatic RCC should be sought.

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“…C ancer of the clivus is caused by primary osseous or chondral lesions, such as chordomas or chondrosarcomas, local spread of oropharyngeal masses, and metastasis of solid or hematopoietic tumors (1)(2)(3)(4). Because the sixth nerve traverses the tight space of the Dorello canal adjacent to the clivus, it is readily compromised by a tumor, such that sixth nerve palsy may be a presenting sign (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

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confidence: 99%

MRI Diagnosis of Clival Cancer and Sixth Nerve Palsy

Halawa¹,

Kim²,

Liao³

et al. 2022

Journal of Neuro-Ophthalmology

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Background:Imaging diagnosis of clival cancer may be difficult, in part because of normal variation in marrow signal with aging. Identifying whether clival cancer has damaged the sixth cranial nerve is a further challenge because minimal clival abnormalities could impinge on the nerve, which travels very close to the clivus.Methods:Two neuroradiologists, who were unaware of previous imaging and clinical diagnoses, reviewed MRI studies of 25 patients with cancer but no clival involvement and no sixth nerve palsy, 24 patients with clival cancer but without sixth nerve palsy, and 31 patients with clival cancer and sixth nerve palsy. The radiologists were tasked with determining whether there was clival cancer, whether there was a sixth nerve palsy and its laterality, and with indicating the pulse sequences used to make those determinations.Results:Both neuroradiologists correctly identified all 25 cases with a normal clivus. In about half of those cases, they depended on finding a homogeneously bright marrow signal; in the remaining cases, they excluded cancer by determining that the clivus was not expanded and that there were no focal signal abnormalities. Both neuroradiologists correctly identified clival cancer in 54 (98%) of the 55 cases with and without sixth nerve palsy. In doing so, they relied mostly on clival expansion but also on focal signal abnormalities. Both neuroradiologists were at least 80% correct in identifying a sixth nerve palsy, but they often incorrectly identified a palsy in patients who did not have one. When there was a one-sided signal abnormality or the clivus was expanded in one direction, both neuroradiologists were accurate in identifying the side of the sixth nerve palsy.Conclusion:Current MRI pulse sequences allow accurate differentiation of a normal from a cancerous clivus. When the marrow signal is not homogeneously bright in adults, cancer can be diagnosed on the basis of clival expansion or focal signal abnormalities. MRI is less accurate in predicting the presence of a sixth nerve palsy. However, the side of a unilateral palsy can be predicted when the clivus is clearly expanded in one direction or there is a focal signal abnormality on one side.

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Isolated clival metastasis as the cause of abducens nerve palsy in a patient of breast carcinoma: A rare case report

Cited by 13 publications

References 12 publications

Isolated unilateral sixth nerve palsy in a patient with nasopharyngeal carcinoma

Isolated unilateral sixth nerve palsy in a patient with nasopharyngeal carcinoma

Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit

MRI Diagnosis of Clival Cancer and Sixth Nerve Palsy

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