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KMID : 1036520200100010008
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Clinical Neuro-Ophthalmology
2020 Volume.10 No. 1 p.8 ~ p.12
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Nasopharyngeal Carcinoma Presenting With Isolated Bilateral Abducens Nerve Palsies
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Im Jae-Hwan
Kim Jae-Myung
Ko Sang-Jun
Cho Ki-Hyun
Lee Seung-Han
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Abstract
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Abducens nerve palsy is known to be the most common ocular motor cranial neuropathy with usually benign clinical course. However, due to its long course in the prepontine cistern and cavernous sinus, abducens nerve can be damaged by various intracranial lesions. Also, the epidemiologic studies occasionally reported abducens nerve palsy due to neoplastic origin which may lead to poor prognosis. Here we report a case of nasopharyngeal carcinoma presenting with isolated, consecutive abducens nerve palsies. A 55-year-old man with hypertension presented with 2 weeks of worsening binocular horizontal diplopia. He had a history of persistent isolated abducens nerve palsy in the right for 4 months. Neuro-ophthalmologic examination revealed bilateral abducens nerve palsies. Brain MRI demonstrated ill-defined, enhancing soft tissue mass in sphenoid sinus and clivus extending to both cavernous sinuses and nasopharyngeal mucosa. Endoscopic biopsy confirmed the diagnosis of non-keratinizing, differentiated type of nasopharyngeal carcinoma. Even in patients with vascular risk factors, if the symptoms persisted for more than several months or clinical manifestations were atypical (e.g., bilateral involvement), clinicians should consider other etiologies such as tumor than microvascular ischemia as a cause of abducens nerve palsy.
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KEYWORD
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Abducens nerve palsy, Diplopia, Nasopharyngeal carcinoma
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