title: Abducens (sixth) nerve palsy presenting as a rare case of isolated brainstem metastasis from a primary breast carcinoma.
abstract: Most isolated abducens (sixth) nerve palsies are ischaemic in nature. However, there are other causes that can mimic an abducens nerve palsy, which requires aggressive diagnostic management. A 56-year-old hypertensive woman presented with a right abduction deficit. Her past history revealed that she had undergone a mastectomy and completed a course of chemo- and radiation therapy for breast carcinoma. She was well until she develped binocular diplopia five months later. Magnetic resonance imaging showed a right pontine mass. Stereotactic biopsy was performed, and histopathology revealed a metastatic carcinoma that was compatible with an origin from the breast primary. We conclude that identifying and managing patients with metastatic lesions involves a multidisciplinary approach. Thorough history-taking and neuro-ophthalmologic evaluation would help physicians in establishing the primary differentials, which could not only be sight-saving but life-saving as well.
authors.affiliation: Neuro-Ophthalmology Service, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. kurr_b_reyes@yahoo.com
authors.forename: K B
authors.initials: KB
authors.lastname: Reyes
authors.forename: H Y
authors.initials: HY
authors.lastname: Lee
authors.forename: I
authors.initials: I
authors.lastname: Ng
authors.forename: K Y
authors.initials: KY
authors.lastname: Goh
mesh_terms: D020434:Abducens Nerve Diseases / Q000150:complications* / Q000175:diagnosis*; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001933:Brain Stem / Q000473:pathology*; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology*; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis
chemical_list: D003287:Contrast Media