Yeungnam Univ J Med.  2019 May;36(2):159-162. 10.12701/yujm.2019.00129.

Rapid progression from trochlear nerve palsy to orbital apex syndrome as an initial presentation of advanced gastric cancer

• Kong E
• Koh SA
• Kim WJ

• KMID: 2449331
• DOI: http://doi.org/10.12701/yujm.2019.00129

Abstract

The most cases with orbital metastases have been reported in patients with a prior established diagnosis of cancer and widespread systemic involvement. However, ocular symptoms can be developed as an initial presentation of cancer in patients without cancer history. We report a case of rapid progression from trochlear nerve palsy to orbital apex syndrome as an initial presentation of advanced gastric cancer.

Keyword

Diplopia; Metastasis; Optic neuropathy; Stomach neoplasms; Trochlear nerve palsy

MeSH Terms

Diagnosis
Diplopia
Humans
Neoplasm Metastasis
Optic Nerve Diseases
Orbit*
Stomach Neoplasms*
Trochlear Nerve Diseases*
Trochlear Nerve*

Figure

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  Fig. 1. Axial magnetic resonance imaging of the brain with contrast showing enlargement and enhancement of the left orbital apex (arrow) through the cavernous sinus (A). This lesion (arrow head) was also suspected in previous neuroimaging performed 2 months earlier (B).

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  Fig. 2. Transaxial PET, PET/CT, PET/MRI show a hypermetabolic soft tissue mass (arrows, SUVmax 3.7) extending to the optic canal and superior orbital fissure (A-C). The left superior oblique muscle (arrow) shows asymmetrically decreased physiological uptake, representing denervation injury (D). PET, positron emission tomography; CT, computed tomography; MRI, magnetic resonance imaging; SUVmax, maximum standardized uptake value.

Reference

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