History & Exam A 62-year-old woman presented with a one-month history of severe light sensitivity and headache, and a two 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 Crohn's disease, for which she had undergone a partial colectomy. Her only medication was ranitidine. Review of systems was unremarkable. Neuro-ophthalmic examination revealed visual acuity of 20/20 OU. She had normal anterior segments, pupillary reactions, and fundi OU. Motility assessment showed an isolated left abduction deficit. The fifth and seventh cranial nerves were intact. There was no ptosis, proptosis, or nystagmus. CT scan of the brain revealed a 3.6 x 2.4 cm lesion centered on the left skull base. It extended to and filled most of the sphenoid sinus. There was bony destruction, with complete destruction of the petrous apex. The mass also broke through the clivus to extend into the premedullary cistern. There were areas of hyperdensity within the mass. MRI showed a large lesion of the left clivus and petrous bone. It was hyperintense on TI and enhanced homogeneously with gadolinium. The mass was shown to extend to the lower aspect of the sella. The patient underwent a metastatic workup. Her blood work was significant for an elevated alkaline phosphatase of 155 and a carcinoembryonic antigen of 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, a serum marker for pancreatic cancer, was less than one. A diagnostic study was performed.
Date
2015
Language
eng
Format
video/mp4
Type
Image/MovingImage
Relation is Part of
NANOS Annual Meeting Frank B. Walsh Sessions; 2015
