Cavernous sinus syndrome — SCE Neurology MCQ

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HardCranial NeuropathiesCavernous sinus syndromeSCE Neurology

A patient with breast cancer develops painful ophthalmoplegia, ptosis and numbness over the forehead. Examination shows ipsilateral III, IV, VI and V1 deficits with preserved visual acuity and no optic-disc abnormality. Where is the lesion?

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Correct answer: A — The ipsilateral cavernous sinus

The best answer is “The ipsilateral cavernous sinus”. The cavernous sinus contains ocular motor nerves and the first trigeminal division in close proximity; combined painful ophthalmoplegia and V1 sensory loss localise there and in cancer demand urgent contrast imaging for metastasis or thrombosis. “The contralateral occipital cortex” is less appropriate because occipital cortex lesions cause visual-field defects rather than multiple cranial neuropathies “The ipsilateral lateral medulla” is less appropriate because lateral medullary lesions do not group III, IV, VI and V1 palsies “The optic chiasm” is less appropriate because chiasmal disease causes visual-field loss without this ocular-motor pattern “The neuromuscular junction” is less appropriate because junctional disease can cause fluctuating ophthalmoplegia but not fixed V1 sensory loss

Reference: NICE NG127: Suspected neurological conditions — recommendations. https://www.nice.org.uk/guidance/ng127/chapter/Recommendations