Multiple cranial nerve palsies as the presenting features of prostate carcinoma

Cranial nerve palsy caused by metastasis to the skull base in patients with castration-resistant prostate cancer: Three case reports

INTRODUCTION

Skull base metastasis of prostate cancer associated with cranial nerve palsy is rare. We observed three patients with aggressive prostate cancer who experienced cranial nerve palsy.

CASE PRESENTATION

Case 1 was a 53-year-old patient who was treated with carboplatin and etoposide. He noticed sensory abnormalities on his left mouth edge. Head magnetic resonance imaging revealed skull base metastasis. Case 2 was a 50-year-old patient who received docetaxel. This patient exhibited ptosis of the left eye. Skull base metastasis was detected by magnetic resonance imaging. External beam radiation therapy was performed. Case 3 was a 64-year-old patient who was treated with docetaxel. He experienced ptosis of the right eye and diplopia. He was also treated with external beam radiation therapy.

CONCLUSION

External beam radiation therapy exhibited some efficacy against the symptoms, but skull base metastasis of treatment-resistant prostate cancer has poor prognosis. Three patients died within 3 months after symptoms occurred with or without external beam radiation therapy.

The truth is in the water: metastatic prostate cancer presenting as an intermittent facial nerve palsy

An elderly man presented to the acute ear, nose and throat (ENT) services with a history of intermittent, self-limiting facial nerve palsy. Full ENT examination was normal, with all cranial nerves and peripheral neurology intact. Multiple imaging modalities suggested an aggressive bony lesion, secondary to locally advanced prostate malignancy with extensive metastatic infiltration. Prostate cancer is known to preferentially metastasise to bone and has been known to cause multiple cranial nerve palsies and ophthalmoplegia. This is the first case described in the literature of metastatic prostate cancer presenting with intermittent facial nerve palsy.

Atrophy of the tongue as the presenting feature of metastatic prostate cancer

Prostate cancer is the most frequently diagnosed solid organ cancer in men and is the second leading cause of cancer-related deaths in men in the United Kingdom. Commonly, it metastasizes to bones and lymph nodes, however, in advanced hormonerefractory disease it may involve the skull base leading to associated cranial nerve palsies. Cranial nerve palsy as the presenting feature of advanced hormone-sensitive prostate cancer is extremely rare. To the best of our knowledge, we report the first case of solitary hypoglossal nerve palsy as the presenting feature of advanced prostate cancer. Neurologists, neurosurgeons and otolaryngologists may be the first clinicians to see such a patient; therefore, prostate cancer should be amongst the differential diagnoses considered in middle-aged and elderly men presenting with a cranial neuropathy and evidence of skull metastasis.

Multiple cranial neuropathy as the initial presentation of metastatic prostate adenocarcinoma: case report and review of literature

The skull base is an atypical metastatic site for prostate carcinoma. It is usually encountered late in the disease process in patients with known advanced disease. However, skull base involvement causing cranial nerve palsies may rarely be the presenting sign of prostate carcinoma. Such patients may present to a number of specialties including neurosurgery and can pose a diagnostic challenge in the absence of lower urinary tract symptoms. Here, we describe an unusual case of prostate adenocarcinoma presenting as a central skull base tumour with multiple cranial neuropathy.

Midline shift, seizures and acute neurological deterioration due to cranial vault metastases from prostatic carcinoma

Intracranial metastases from prostatic cancer are rare, but cranial vault metastases are not. Most patients who have vault metastases present with local symptoms such as pain. We describe a patient who presented with acute neurological symptoms as well as a midline shift, seizures and secondary intracranial effects as a result of the extensive cranial vault metastases from prostate cancer; the symptoms mimicked those of intracranial metastases.