Sixth Cranial Nerve Palsy Caused by Gastric Adenocarcinoma Metastasis to the Clivus

Abstract

Tumors of the clivus and metastases to the clivus are very rare. Metastasis involving the clivus has previously been described in only two case reports. In skull metastasis, the breast and prostate are the most common primary foci, while metastasis from gastric carcinoma is extremely rare. A review of the English literature revealed only one published case of clivus metastases from gastric adenocarcinoma. There is no literature thoroughly explaining the differential diagnosis between chordoma and metastasis. Here we report a rare case of metastasis to the clivus from a gastric adenocarcinoma in a 42-year-old female patient with sudden blurry vision, presenting as bilateral cranial nerve VI palsy.

Anterior Clinoid Metastasis as First Presentation of a Signet Ring Cell Carcinoma: An Intriguing Diagnosis

“…The prognosis of bone metastasis caused by gastric cancer is very poor and the prognosis of patients can be even worse due to a delayed diagnosis. [17][18][19][20][21][22][23] Tumor removal and optic nerve decompression were performed through an extradural clinoidectomy. Extradural removal of the ACP had been extensively described as part of the surgical approach for vascular lesions and skull base tumors.…”

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

“…Majority of the reports of metastases to the clivus have been reported in case reports, case images, or series [ 15 ]. See Table 1 summarizing specifically renal cell carcinoma cases with metastases to the clivus [ 4 , 5 ] and Table 2 summarizing all clival metastases from different primary sites [ 5 , 14 – 18 ]. Metastases to the clivus have arisen from sites such as the prostate, breast, and stomach [ 7 , 18 ].…”

“…See Table 1 summarizing specifically renal cell carcinoma cases with metastases to the clivus [ 4 , 5 ] and Table 2 summarizing all clival metastases from different primary sites [ 5 , 14 – 18 ]. Metastases to the clivus have arisen from sites such as the prostate, breast, and stomach [ 7 , 18 ]. Late recurrence of cancer with metastasis to the clivus after a period of remission has been reported [ 13 ].…”

“…It is imperative that we consider the anatomy of the clivus and the abducens nerve. The clivus is a surface of a segment of the occipital and sphenoid bones in the skull surrounded by neurovascular structures of the brainstem and both internal carotid arteries [ 18 ]. The abducens nerve arrives at the subarachnoid space after leaving the pons.…”

Difficulty in Diagnosing a Case of Severe Headache Caused by Lung Cancer Metastasis to Base of Skull Due to Lack of Imaging Evidence

“…Shiro Tomiyasu, 1) Akiko Masaki, 2) Yukari Matsuo, 3) Hiroshi Nishida, 4) and Hidetoshi We report a case of severe headache caused by lung cancer metastasis to the base of the skull that was difficult to diagnose due to a lack of imaging evidence. Case: A 70-year-old man diagnosed with advanced lung cancer experienced sudden, severe headache.…”