Recurrent Facial Palsy Occurring with Metastatic Thymic Carcinoid and Nonarteritic Ischemic Optic Neuropathy

Skibell, Bentley C.; Hesse, Richard J.

doi:10.1097/01.iop.0000056025.65389.c3

Ophthalmic Plastic & Reconstructive Surgery

2003

DOI: 10.1097/01.iop.0000056025.65389.c3

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Recurrent Facial Palsy Occurring with Metastatic Thymic Carcinoid and Nonarteritic Ischemic Optic Neuropathy

Bentley C. Skibell¹,

Richard J. Hesse²

Abstract: A 74-year-old man was diagnosed with thymic carcinoid metastatic to the mediastinum. Two years later, he developed left and then right facial palsy. Four additional episodes of facial palsy developed within 2 years, followed by an occurrence of nonarteritic ischemic optic neuropathy. While recurrent facial palsy is uncommon, it may occur in the presence of various systemic conditions such as carcinoid, diabetes, infection, and neoplasm. The presence of recurrent facial palsy logically warrants an evaluation fo… Show more

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2008

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Paraneoplastic vasculitic neuropathy related to carcinoid tumor

2008

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LETTER TO THE EDITORSJON 2825 muscle groups. Cutaneous sensibility was diminished in the right ulnar and left median distribution and in both feet. Vibratory perception was reduced at the toes, ankles and knees but proprioception was normal. Reflexes were trace at the knees and ankles but were normal in the arms. Toes were flexor.Serum chromogranin A and serotonin levels were elevated at 464 ng/ml (Normal: 0-76 ng/ml) and 602 ng/ml, respectively. A slight elevation of the β fraction and slight reduction in the γ fraction was seen on serum immunofixation electrophoresis. ANCA IgG was < 1:16 and anti-nuclear antibody < 1. Bone marrow aspirate and biopsy showed 2 % plasma Sirs: Non-metastatic neuromuscular complications of carcinoid include a neuropathy, serotonin-related myopathy and inflammatory myopathy [1, 3, 4, 6-8, 10, 11, 13-15]. A paraneoplastic etiology has been proposed for some neuropathies [3, 7, 13] but unlike with other tumors [11], a paraneoplastic vasculitic neuropathy (VN) has never been described with carcinoid. We describe a patient with metastatic carcinoid tumor who developed a VN in conjunction with increasing tumor activity. Tumor resection led to stabilization of the VN suggesting a paraneoplastic etiology.A 71 year old male developed symmetric painless proximal leg weakness over three days in February 2004. He also developed episodic palpitations, sweating and chest pain -symptoms which were later recognized as carcinoid syndrome. He was seen by us in September 2004 and reported acute onset of severe pain, weakness and numbness in the right hand, in the ulnar distribution. Examination revealed atrophy of the ulnar innervated muscles of the right hand (first dorsal interosseus MRC grade 3.5). Strength was normal in other cells. CSF analysis showed protein level of 69 mg/dl but was otherwise unremarkable. Anti-ENA antibodies, rheumatoid factor, complement levels, hepatitis B and C serology, serum cryoglobulin levels and antineuronal antibodies were unremarkable.Abdominal CT scan showed a small soft tissue structure in the small bowel mesentery which, on biopsy, showed a well-differentiated endocrine tumor that was positive for chromogranin, synaptophysin and cytokeratin 20 and negative for cytokeratin 7 supporting the diagnosis of a carcinoid tumor. Octreoscan revealed increased

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Paraneoplastic vasculitic neuropathy related to carcinoid tumor

2008

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Recurrent facial nerve palsy caused by a facial cyst

2008

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Mr B first presented to the authors' department in 2001 complaining of right-sided facial weakness. He was diagnosed with a grade 2 facial nerve palsy for which no obvious cause was identified. He was actively treated with aciclovir and steroids and his symptoms resolved completely. Over the next 2 years, he suffered two similar episodes that responded well to similar treatment. One year later, he was referred to the clinic with a grade 3 facial nerve palsy. A computed tomography scan showed no abnormality along the course of the right facial nerve. Genetic tests showed no genetic cause for the recurrent facial nerve palsy. His symptoms initially resolved but 6 months later he was readmitted with a grade 4 facial nerve palsy. A magnetic resonance imaging scan showed inflammation of the tympanic and mastoid sections of the facial nerve and facial nerve decompression surgery was planned. Intra-operatively, mild oedema was evident along the intratemporal course of the facial nerve. During decompression of the mastoid (horizontal) segment of the facial nerve (Figure 1), a significant amount of mucoid fluid in keeping with a benign cyst was drained (Figure 2). His facial palsy fully resolved and a magnetic resonance imaging scan performed 1 year after surgery showed no evidence of recurrence or other pathology. At 3-year follow up, there was no recurrence of symptoms.

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Recurrent Facial Palsy Occurring with Metastatic Thymic Carcinoid and Nonarteritic Ischemic Optic Neuropathy

Cited by 2 publications

References 6 publications

Paraneoplastic vasculitic neuropathy related to carcinoid tumor

Paraneoplastic vasculitic neuropathy related to carcinoid tumor

Recurrent facial nerve palsy caused by a facial cyst

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