Isolated oculomotor nerve palsy as the presenting clinical manifestation of a meningeal carcinomatosis: a case report

Abstract

We present a previously unreported case of isolated oculomotor nerve palsy as the inaugural clinical sign of meningeal carcinomatosis (MC). Gadolinium-enhanced magnetic resonance images (MRI) were unremarkable. Cerebrospinal fluid (CSF) analysis showed malignant cells consistent with a pulmonary adenocarcinoma; the chest CT revealed a small pulmonary mass in the upper right lobe. This case highlights the importance of considering MC in all patients who develop sudden oculomotor palsy; lumbar punctures should always be performed on patients with normal MRI when other possible causes of oculomotor palsy have been ruled out.

Meningeal carcinomatosis: a retrospective analysis of seventy-seven cases

“…The other cranial nerves such as optic nerve, auditory nerve, hypoglossal nerve, glossopharyngeal nerve also can be involved, which was similar with what already described in the literature. [9] In this study, there were 12 (15.6%) patients with bilateral limbs weakness or paresthesia, 11 (14.3%) patients with tendon reflexes diminished or disappeared, 5 (6.5%) patients with the neck shoulder pain which is the effect of the infiltration of tumor cells and the irritation of the spinal nerve root. In addition, there was one case with rectal bladder dysfunction and saddle area sensory deficiency.…”

Patient of carcinoma cervix presenting with oculomotor palsy due to meningeal carcinomatosis- a case report

“…1 An isolated third nerve palsy in MC has also rarely been described. [2][3][4] To our knowledge, there is no previously reported case of isolated oculomotor nerve palsy in a patient of cervical cancer. In patients with MC, MRI with gadolinium usually demonstrates meningeal enhancement or hydrocephalus.…”

Commentary

“…The incidence of MC appears to be increasing, perhaps due to longer survival of patients with malignant neoplasms and the improvements in neuroimaging techniques. MC has been reported to occur in to 2% to 25% of patients with malignancy or cancer, [1][2][3] and typically has a poor prognosis even with an aggressive treatment. [1] Although often found in patients with known metastatic malignancies, MC can also be the initial manifestation of an underlying malignancy.…”

“…An MRI with gadolinium is the only imaging modality, necessary to confirm diagnosis in suspected neoplastic letpomeningeal disease. [2] In comparing 3 MRI sequences, contrast-enhanced fast FLAIR sequences are less sensitive than standard contrast-enhanced T1-weighted MR sequences in detecting intracranial neoplastic leptomeningeal disease. However, Nardone [2] reports that, MRIs of the brain may also appear completely normal.…”