McAvoy C E, Kamalarajab S, Best R, Rankin S, Bryars J, Nelson K
Department of Ophthalmology Royal Victoria Hospital Belfast Northern Ireland, UK.
Eye (Lond). 2002 Nov;16(6):749-53. doi: 10.1038/sj.eye.6700210.
To report four cases of cranial nerve palsy, which presented to the ophthalmologist as the only or one of the earliest manifestations of prostatic carcinoma. This is an infrequent complication of metastatic prostatic carcinoma usually only occurring late in the disease process in those with a history of prostatic carcinoma.
The case records of four patients with a history of a cranial nerve palsy who attended the ophthalmology department and who had a recent or subsequent diagnosis of prostatic carcinoma were reviewed.
Diplopia caused by lesions affecting the third and sixth nerves sometimes in association with sensory symptoms may be a manifestation of metastatic prostatic carcinoma. These findings are consistent with base of the skull metastases from the condition. Two patients are still alive 54 months and 12 months after the diagnosis. One of the patients died 13 months after the diagnosis of prostatic carcinoma was made and the other died 21 months after the diagnosis from an unrelated hypertensive brain haemorrhage.
Any patient presenting with diplopia must have an adequate past medical history taken and in an elderly gentleman this should include symptoms of prostatic disease. If indicated urological referral and measurement of prostate specific antigen may be performed. In patients whose cranial nerve palsy is complicated by other sensory signs or those in whom no sign of recovery occurs in 2 months, a contrast CT scan asking for bone windows to be included may be helpful in delineating any pathology. Radiotherapy may be useful for the treatment of metastatic prostatic carcinoma causing cranial nerve palsies with some patients experiencing either complete or partial resolution of their symptoms. The effect of newer hormonal agents or chemotherapy on this aspect of the disease is not well documented in current literature.
报告4例颅神经麻痹病例，这些病例作为前列腺癌唯一或最早的表现之一出现在眼科医生处。这是转移性前列腺癌罕见的并发症，通常仅在有前列腺癌病史的患者疾病晚期出现。
回顾了4例有颅神经麻痹病史且到眼科就诊、近期或随后被诊断为前列腺癌的患者的病历。
影响第三和第六神经的病变有时伴有感觉症状导致的复视可能是转移性前列腺癌的一种表现。这些发现与该病颅骨底部转移相符。两名患者在诊断后54个月和12个月仍存活。其中一名患者在前列腺癌诊断后13个月死亡，另一名患者在诊断后21个月死于无关的高血压脑出血。
任何出现复视的患者都必须有详尽的既往病史记录，对于老年男性，这应包括前列腺疾病症状。如有指征，可进行泌尿外科转诊及前列腺特异性抗原检测。对于颅神经麻痹伴有其他感觉体征的患者或2个月内无恢复迹象的患者，进行包括骨窗的增强CT扫描可能有助于明确任何病变。放疗可能对治疗导致颅神经麻痹的转移性前列腺癌有用，一些患者的症状可完全或部分缓解。目前文献中关于新型激素药物或化疗对该病这方面影响的记载并不充分。
