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

Abstract

Abstract

Nasopharyngeal carcinoma presenting as a sixth nerve palsy and Horner’s syndrome

“…The largest case series on the topic of combined sixth nerve palsy and Horner’s syndrome was by Ebner et al 4 who included five cases due to cavernous sinus meningiomas (n=2), carotid-cavernous anuerysm, metallic foreign body and squamous cell carcinoma. Additional case reports have documented additional causes such as a cavernous-carotid aneurysms,5 6 petrous interal carotid artery aneurysm,7 carotid cavernous-sinus fistula,8 9 facial abscess,10 herpes zoster ophthalmicus arteritis11 and metastatic carcinomas 12 13. Nasopharyngeal carcinoma may also cause a sixth nerve palsy and ipsilateral Horner’s syndrome.…”

Horner's Syndrome with Abducens Nerve Palsy

“…When these rare clinical features are manifested, we have to consider paratrigerminal syndrome or a lesion of the posterior cavernous sinus [1]. Sympathetic nerve fibers travel over the wall of the carotid artery and in the cavernous portion the fibers leave the ICA and accompany the abducens nerve for only a few millimeters in the posterior portion of the sinus [4,10,12,16] (Fig. 5).…”

“…To date, only 13 cases with this combination of symptoms secondary to metastatic neoplasm within the cavernous sinus have been reported [4,10-16]. Regarding the primary lesions in these cases, there were 1 small cell lung cancer [10], 1 parotid cancer [10,12], 1 breast cancer [11], 1 gastric cancer [10], 1 uterine cancer [4], 3 undetermined origins [13,14] and 3 nasopharyngeal cancers [15]. Unlike in other three nasopharyngeal cancer cases reported by Hirao et al [15], the cancer only invaded the 6th nerve and sympathetic fiber without involvement of the 5th nerve in this case.…”

“…Nasopharyngeal carcinoma can spread through the foramen lacerum and invade the cavernous sinus, resulting in cranial nerve injuries [7]. In previous reports, there have been only 13 cases of combined abducens nerve palsy and ipsilateral Horner's syndrome secondary to metastatic neoplasm within the cavernous sinus [4,10-16]. Here, we report a case with a combination of 6th nerve palsy and incomplete Horner's syndrome caused by invasive nasopharyngeal cancer in the cavernous sinus.…”

“…It contains the oculomotor, trochlear, abducens, and the first two divisions of the trigerminal nerve as well as the oculosympathetic nerve plexus around the internal carotid artery [3-6]. These anatomical particularities are causes of solitary or combined diverse impairments of cranial nerves and postganglionic Horner's syndrome [1,3,4,7]. Tumour involvement of the cavernous sinus region due to distant metastasis or local extension has been reported in <1% of cancer patients [3,7].…”