Combination of Abducens Nerve Palsy and Ipsilateral Postganglionic Horner Syndrome as an Initial Manifestation of Uterine Cervical Cancer

Hiromasa Tsuda, Yasuko Yorinaga, Yutaka Tamada, Shouji Kutsuki, Takashi Nakanoma, Koki Tai, Masahiro Yoshioka, Naoki Ishihara, Yumi Sekine, Hiroshi Ishikawa
2009 Internal medicine (Tokyo. 1992)  
A 74-year-old woman presented with abducens nerve palsy, postganglionic Horner syndrome and sensory disturbance in the territory of the ophthalmic nerve on the left side. Cranial magnetic resonance imaging demonstrated a gadolinium-enhanced lesion within the left cavernous sinus. Thereafter, uterine cervical cancer was detected as the origin of this intra-cavernous sinus metastasis. We emphasize that the combination of abducens nerve palsy and ipsilateral postganglionic Horner syndrome may
more » ... r syndrome may indicate a lesion located within the posterior portion of the cavernous sinus or in its vicinity. Moreover, this is the first reported case of uterine cervical cancer with intra-cavernous sinus metastasis. A 74-year-old woman without contributory medical history complained of sudden onset horizontal diplopia and consulted our hospital on May 2008. A slight restriction of abduction was observed in the left eye. There were no other neurological deficits. Cranial computed tomography did not demonstrate any abnormalities. Therefore, she was considered as having ischemic isolated left abducens nerve palsy. However, because horizontal diplopia gradually worsened under oral methylcobalamine at 1.5 mg/day, she returned to our hospital 2 weeks later. She reported the absence ocular pain and headache. Corrected visual acuity was 1.0 in both eyes. Fundscopic findings did not demonstrate any abnor-
doi:10.2169/internalmedicine.48.2319 pmid:19687598 fatcat:f5ja563jzzfo7fc2bcwtomr6ha