Horizontal Gaze Palsy as an Initial Manifestation of Nasopharyngeal Carcinoma

Abstract

A 70-year-old man was unable to move both eyes to the left side. Ocular motility examination revealed an esotropia and left gaze paralysis. Jugulo-digastric lymph node and bulging nasopharyngeal roof were also observed. A brain MRI revealed a mass involving cavernous sinus, clivus, prepontine cistern and the lower pons. Pathologic examination of the tissue biopsied from the nasopharynx revealed a non-keratinizing squamous cell carcinoma. He was treated with radiotherapy 6600 cGy at tumor and 6600 cGy at the neck node. The neck mass and deficit of the right eye adduction deficit improved but the left eye abduction persisted.