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01.12.2014 | Case report | Ausgabe 1/2014 Open Access

Journal of Medical Case Reports 1/2014

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

Journal of Medical Case Reports > Ausgabe 1/2014
Indira M Madgula, Christopher M Hemmerdinger, Peter Clark
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-8-430) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

IM and CH examined and managed the patient in the ophthalmology clinic. PC managed the patient in oncology services. IM was a major contributor in writing the manuscript. All authors read and approved the final manuscript.



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.


Metastatic cancer may manifest as cerebral metastases or carcinomatous meningitis. This is evident on neuroimaging with contrast and may be missed on unenhanced scans.

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Authors’ original file for figure 1
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