RESUMO
A 52-year-old patient was initially diagnosed as hypophosphatemic osteomalacia in the Department of Endocrinology due to knee, foot and lumbosacral pain. The symptoms were not significantly relieved after phosphorus and vitamin D supplementation. Later, the imaging examination showed an orbital tumor in the right eye. The tumor was surgically removed, and the symptoms of systemic bone pain were relieved.
Assuntos
Hipofosfatemia , Neoplasias Orbitárias , Osteomalacia , Humanos , Hipofosfatemia/induzido quimicamente , Hipofosfatemia/complicações , Pessoa de Meia-Idade , Neoplasias Orbitárias/complicações , Osteomalacia/induzido quimicamente , Osteomalacia/diagnóstico , Dor/complicações , Síndromes ParaneoplásicasRESUMO
A 71-year-old man, living with metastatic castrate-resistant prostate cancer to the lymph nodes, spine and skull, presented with acute on chronic left eye vision loss. Examination revealed no-light-perception vision, a relative afferent pupillary defect and optic disc cupping. MRI brain revealed optic canal narrowing from metastatic sphenoid bone expansion and extraosseous tumour compressing the intracanalicular optic nerve. The optic disc cupping and excavation without significant pallor of the remaining neuroretinal rim was likely secondary to chronic compression of the optic nerve. The patient was treated with radiation therapy, but did not regain vision and was referred to palliative care as his condition continued to worsen. As patients live longer with advanced cancer, there is a greater risk of metastasis to atypical areas of the body including the optic nerve. This case demonstrates the unique combination of optic disc cupping from optic canal metastasis due to prostate cancer.
Assuntos
Cegueira/etiologia , Síndromes de Compressão Nervosa/etiologia , Nervo Óptico/patologia , Neoplasias Orbitárias/diagnóstico , Neoplasias da Próstata/patologia , Idoso , Cegueira/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Síndromes de Compressão Nervosa/diagnóstico , Nervo Óptico/diagnóstico por imagem , Neoplasias Orbitárias/complicações , Neoplasias Orbitárias/radioterapia , Neoplasias Orbitárias/secundário , Neoplasias da Próstata/terapia , Radiocirurgia , Acuidade VisualRESUMO
Retro-orbital tumour was the cause of headache and neuropathic facial pain in a 31-year-old pregnant woman. The diagnosis had been overlooked as a result of a long history of migraine. There was exacerbation of the pain throughout the pregnancy, particularly in the third trimester. Pharmacological agents commonly used to manage neuropathic pain states were relatively contraindicated due to potential adverse effects on the fetus. Cognisant of such limitations imposed by pregnancy, we used multimodal therapy in an attempt to control the pain. This included morphine, paracetamol, amitriptyline, ketamine and psychological support. The management challenges are described.