Shady Double Crosser

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Identifier walsh_2015_s1_c4-2
Title Shady Double Crosser
Creator Francine Wein
Affiliation McGill University Montreal, QC, Canada
Subject Photophobia; Diplopia; Metastasis; Skull Base
History A 62-year-old woman presented with a one-month history of severe light sensitivity and headache, and atwo week history of diplopia. Her photophobia was severe enough for her to wear sunglasses indoors.Her past medical history was significant for a cholecystectomy and Crohns disease, for which she hadundergone a partial colectomy. Her only medication was ranitidine. Review of systems wasunremarkable. Neuro-ophthalmic examination revealed visual acuity of 20/20 OU. She had normalanterior segments, pupillary reactions, and fundi OU. Motility assessment showed an isolated leftabduction deficit. The fifth and seventh cranial nerves were intact. There was no ptosis, proptosis, ornystagmus. CT scan of the brain revealed a 3.6 x 2.4 cm lesion centered on the left skull base. Itextended to and filled most of the sphenoid sinus. There was bony destruction, with completedestruction of the petrous apex. The mass also broke through the clivus to extend into the premedullarycistern. There were areas of hyperdensity within the mass. MRI showed a large lesion of the left clivusand petrous bone. It was hyperintense on TI and enhanced homogeneously with gadolinium. The masswas shown to extend to the lower aspect of the sella. The patient underwent a metastatic workup. Herblood work was significant for an elevated alkaline phosphatase of 155 and a carcinoembryonic antigenof 61.6. CT of the chest was unremarkable. Abdominal CT showed several hypodense liver lesions,suggesting metastases. A 2.5 x 2.1 cm hypodense mass was present in the pancreatic tail. CA19-9, aserum marker for pancreatic cancer, was less than one. A diagnostic study was performed.
Disease/Diagnosis Pancreatic adenocarcinoma metastatic to the skull base
Date 2015-02
References 1. Park KS, Kim M, Park SH, Lee KW. Nervous system involvement by pancreatic cancer. J Neurooncol63:313-316, 2003. 2. Lemke J et al. Brain metastasis in pancreatic cancer. Int J Mol Sci 14:4163-4173, 2013
Language eng
Format application/pdf
Format Creation Microsoft PowerPoint
Type Text
Source 47th Annual Frank Walsh Society Meeting
Relation is Part of NANOS Annual Meeting Frank B. Walsh Sessions; 2015
Collection Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6rr4vv0
Setname ehsl_novel_fbw
ID 179300
Reference URL https://collections.lib.utah.edu/ark:/87278/s6rr4vv0
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