Supraorbital Nerve and Cavernous Sinus Invasion with Poorly Differentiated Carcinoma of Unknown Primary

ABSTRACT

A 50-year-old man presented with a 4-month history of right-sided trigeminal neuropathy in the V1 and V2 distribution, right sixth nerve palsy and Horner syndrome. Magnetic resonance imaging (MRI) showed enhancement and thickening along the right ophthalmic nerve and supraorbital nerve and fullness at the right cavernous sinus extending to Meckel’s cave. Evaluation for a primary tumour was negative. Cavernous sinus biopsy showed infiltrating poorly differentiated carcinoma; the patient underwent radiation therapy. To our knowledge this is the only case of poorly differentiated carcinoma involving the supraorbital nerve presenting with trigeminal neuropathy and Horner syndrome in the English ophthalmic literature.

KEYWORDS:

• Carcinoma
• perineural invasion
• cavernous sinus
• supraorbital nerve

Acknowledgements

Author Contributions: Saagar N. Patel and Mohammad Obadah Nawakah provided original text; Juan Ortiz Gomez, Ama Sadaka, Shauna Berry, Suzanne Powell and Andrew Lee provided editing assistance and review of manuscript.

Declaration of interest

The authors declare that there are no conflicts of interest. The authors alone are responsible for the writing and content of the article.