Isolated IV Nerve Palsy as First Sign in the Diagnostic of Lung Carcinoma

The two most common causes of fourth nerve palsy are trauma and decompensation of a congenital palsy. The nerve can be affect in the midbrain (nucleus of fascicle), in the subarachnoid space, in the cavernous sinus or in the orbital apex. Other non common causes of fourth nerve palsy include infarction, hemorrhage, demyelination, inflammation, infection, tumor and metastasis. The purpose of this poster is to present a case report of an atypical cause of isolated IV nerve palsy due to metastasis of a primary lung tumor unknown until then.

Poster 98 Isolated IV Nerve Palsy as First Sign in the Diagnostic of Lung Carcinoma Luciana Iacono1, Mariana De Virgiliis1, M. Laura Braccia Gancedo1, Haydée Martinez2 1 Hospital Oftalmológico Dr. Pedro Lagleyze, Buenos Aires, Argentina, 2Hospital de Clínicas Jose de San Martin, Buenos Aires, Argentina Introduction: The two most common causes of fourth nerve palsy are trauma and decompensation of a congenital palsy. The nerve can be affect in the midbrain (nucleus of fascicle), in the subarachnoid space, in the cavernous sinus or in the orbital apex. Other non common causes of fourth nerve palsy include infarction, hemorrhage, demyelination, inflammation, infection, tumor and metastasis. The purpose of this poster is to present a case report of an atypical cause of isolated IV nerve palsy due to metastasis of a primary lung tumor unknown until then. Description of Case(s): A 60-year-old male, with no significant past medical history, presented with a 2 weeks story of binocular vertical diplopia. He denied hypertension, Diabetes Millitus, traumas and smoking. The only positive clinical sign revealed during the examination was the hypertropia of his left eye with the typical spontaneous tilt head compensation to the right side. The evaluation of the eyes movements showed the palsy of the left superior oblique. A gadolinium enhanced cranial and orbital MRI was performed. T1weighted MRI without and with contrast demonstrated multiples enhancing brain ring lesions with surrounding vasogenic edema in FLAIR sequence (metastatic lesions). One of dose lesions was clearly identified in the left cavernous sinus, in contact with de IV nerve. A thoracic CT was performed and a mass in the left lower pulmonary lobe was diagnosed. The lung biopsy confirmed an adenocarcinoma as the primary tumor. Conclusions, including unique features of the case(s): Although most common causes of isolated IV nerve palsy are traumatic and congenital, other atypical causes, such as metastasis, must be consider. In this case the IV nerve palsy due to metastatic lesions was the first clinical sign of a pulmonary adenocarcinoma. References: None. Keywords: Tumors, Neuro-ophth & systyemic disease ( eg. MS, MG, thyroid), Ocular Motility, Neuroimaging, Adult strabismus with a focus on diplopia Financial Disclosures: The authors had no disclosures. Grant Support: None. 2018 Annual Meeting | 143