Sixth nerve palsy as the presenting symptom of metastatic colon carcinoma

Abstract

Isolated cranial mononeuropathies in patients over 50 years of age most commonly result from microvascular ischemic demyelination. A 51-year-old female without vasculopathic risk factors presented with isolated sixth nerve palsy. Magnetic resonance imaging (MRI) of the brain and orbits revealed a cavernous sinus lesion that was diagnosed as a meningioma. Laboratory tests showed abnormal liver function, and an abdominal computerized tomogram demonstrated an obstructive colonic mass with liver metastasis. The pathology tests of specimens taken during a laparotomy diagnosed colon adenocarcinoma. The MRI interpretation was changed to cavernous sinus metastasis from a primary adenocarcinoma of the colon. This case had common cranial nerve symptoms but with a very rare etiology, emphasizing the importance of a high index of suspicion of remote origins in patients with isolated sixth nerve palsy and no atherosclerotic risk factors.

Cavernous sinus syndrome associated with metastatic colorectal cancer and perineural spread along the trigeminal nerve

“…In all currently documented cases, metastatic disease was present in other organ systems at the time of diagnosis of cavernous sinus syndrome. 4 , 5 , 6 Furthermore, survival from diagnosis of cavernous sinus involvement ranged from 2 months to 1 year in these cases – a similar prognosis exists with respect to brain metastasis in colorectal carcinoma in which mean survival has been reported to be 4 months (ranging from 1 to 13 months). 7 Our patient passed away 6 months after the onset of his symptoms.…”

“…Colorectal cancer with metastasis to the cavernous sinus has thus far only been reported in 3 cases. 4 , 5 , 6 Thus far, only one case includes histopathologic confirmation of the diagnosis. The remaining cases consist of clinical and radiological diagnoses in the context of existing metastatic disease only.…”

“…3 Cavernous sinus metastasis associated with colorectal cancer is exceedingly rare with less than a handful of documented cases in the literature. 4 , 5 , 6 We report the clinical course and pathology of a patient with biopsy-confirmed cavernous sinus syndrome resulting from metastatic adenocarcinoma of the colon.…”