Metastatic breast cancer presenting as sequential cranial nerve palsy: a case report

INTRODUCTION: Cranial nerve palsy is a common presentation in the neuro-ophthalmology clinic and investigations are directed towards the cause. Metastatic breast cancer presenting as carcinomatous meningitis leading to sequential fourth, third and sixth nerve palsy is very rare. This is the first case to be reported to the best of our knowledge. CASE PRESENTATION: A 66-year-old Caucasian woman presented with vertical double vision for the previous 3 weeks. At 6-weeks follow up this had resolved. However, she presented with a new third and sixth cranial nerve palsy. Neuroimaging with contrast revealed carcinomatous meningitis. CONCLUSIONS: Metastatic cancer may manifest as cerebral metastases or carcinomatous meningitis. This is evident on neuroimaging with contrast and may be missed on unenhanced scans.