Nasopharyngeal Carcinoma with Right Abducens Palsy
A 57-year-old female noticed diplopia for 1 month. She had a history of medically controlled hyperthyroidism. The patient’s thyroid hormone and auto-antibody levels were normal except for mildly elevated anti-thyroglobulin antibody (4.24 IU/mL). She denied other systemic vascular disorders such as diabetes, hypertension, or hyperlipidemia. Her corrected visual acuity was 6/6.7 in the right eye and 6/6 in the left. Intraocular pressures were normal. A Krimsky test showed 12 prism diopters of right esotropia. A prism cover test revealed 12 prism diopters of esotropia on primary gaze, which increased to 35 prism diopters on right gaze and decreased to 2 prism diopters on left gaze. Extraocular movements showed moderate limitation of abduction in the right eye (Fig. 30.1). Anterior segments were normal. Fundoscopic examination showed a normal fundus in both eyes (Fig. 30.2). OCT showed mildly decreased peripapillary retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness in the right eye (Fig. 30.3). MR imaging of the brain showed an increased soft tissue at the lateral recess of the right nasopharynx with an upward extension into the right skull base and right-side cavernous sinus (Fig. 30.4). Nasopharyngoscopy showed a protruding mass with hypervascularity over the right nasopharynx with extension to the right posterior choana region. Nasopharyngeal carcinoma was suspected, but the patient hesitated to undergo a biopsy, and there was subsequent loss to follow-up.
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