Lodhia Vaishali, Puspanathan Thevamalar
Department of Ophthalmology, East Surrey Hospital, Redhill, UK.
Department of Ophthalmology, Queen Elizabeth Hospital, King's Lynn NHS Trust, King's Lynn, UK.
BMJ Case Rep. 2017 Aug 2;2017:bcr-2017-220613. doi: 10.1136/bcr-2017-220613.
An 83-year-old man, a prostate cancer survivor of 10 years with multiple vertebral metastases presented with sudden onset of double vision. On examination he was found to have an isolated partial left abducens palsy with no other neurological deficits. Despite having microvascular risk factors, given his history of prostate cancer, aMRI brain scan was requested to look for a neurological cause. The scan revealed a metastatic lesion in the clivus encasing the cavernous sinus and carotid artery. He was referred to his oncologist for further management, however he opted out of further treatment and succumbed to his illness a month later. This case report includes a literature review of cases with clivus metastases secondary to prostate cancer. It highlights the importance of carefully examining eye movements and having a high index of suspicion for the subtlest sign that may suggest brain metastases in elderly patients with prostate cancer with prolonged survival.
一名83岁男性，前列腺癌幸存者，已患病10年，有多处椎体转移，现突然出现复视。检查发现他仅有孤立性左侧展神经部分麻痹，无其他神经功能缺损。尽管存在微血管危险因素，但鉴于其前列腺癌病史，仍要求进行脑部MRI扫描以寻找神经学病因。扫描显示斜坡有一个转移瘤，包绕海绵窦和颈动脉。他被转介给肿瘤学家进行进一步治疗，然而他选择放弃进一步治疗，一个月后因病去世。本病例报告包括对前列腺癌继发斜坡转移病例的文献综述。它强调了在前列腺癌长期存活的老年患者中，仔细检查眼球运动以及对可能提示脑转移的最细微体征保持高度怀疑的重要性。
