Third nerve paralysis due to cranial metastasis of prostate tumor

Abstract

A 90 years old man presented with outward deviated right eye with droopy lid. These symptoms were developed over a period of two weeks and there was no pain behind the eye. There was no previous history of Diabetes mellitus, hypertension etc. He had a treatment for adenocarcinoma of prostate six years ago. On examination his best-corrected visual acuity was 6/60 in each eye. There was right complete third nerve paralysis with pupil involvement. Anterior segment examination showed nucleosclerotic changes on both sides. Posterior segment examination showed ARMD (dry type) in both eyes. Intraocular pressure and discs were normal. Contrast enhanced MR scan brain revealed a destructive mass at the base of skull at petrous apex on the right side extending forward to orbital apex on the same side. Total body bone scan also showed multiple metastatic lesions. Patient was referred to oncology unit for further management