This elderly man noticed double vision in all areas of gaze, why? What is the cause of this patient's immobile right eye?
Analysis
Watch this video to see the patient's versions.
This patient has clear ptosis. The eye cannot elevate, depress, abduct or adduct.
An MRI of the brian localized opacification in the right cavernous sinus (plasmacytoma) which accounted for a presentation of polycranial neuropathy (third, fourth and sixth cranial nerves affected).
In the 3-minute video discussion, Dr. Paul Freund will
- Discuss the differential diagnosis for multiple cranial neuropathies
- Identify structures that pass through the cavernous sinus
- Review the examination features suggestive of multiple cranial neuropathies
There is increased signal intensity in the cavernous sinus (arrow); the patient was diagnosed with a plasmacytoma.
Neuro Coach Tip
In any patient with multiple simultaneous cranial neuropathies (3rd, 4th, 5th and 6th) consider a cavernous sinus lesion.
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