Progressive, dull, continuous pain in the supraorbital area over the affected eye, diplopia, proptosis of the involved eye, external ophthalmoplegia, first-division trigeminal sensory loss
Ipsilateral frontal headache, oculomotor or abducens palsies without associated proptosis or visual loss
Facial pain or numbness referable to the second or third divisions of trigeminal nerve
Paralysis of cranial nerves IX through Xl
Unilateral occipital pain and unilateral tongue paralysis
Data from Greenberg HS, Deck MDF, Vikram B, et al: Metastasis to the base of the skull: Clinical filldings in 43 patients. Neurology 1981;31:53s537.
most commonly involve the middle cranial fossa. Other sites include the jugular foramen, occipital condyle, parasellar region, and orbit. Metastases to the skull base entrap the cranial nerves and vessels at their exit foramina. Often the cancer appears en plaque as a thin skein of tumor cells. Greenberg has identified five clinical syndromes: orbital, parasellar, middle fossa, jugular foramen, and occipital condyle. y
Owing to their insidious subacute onset, skull-based metastases are difficult to identify on MRI or CT where masses may coalesce with changes of prior irradiation or surgical extirpation. Often the T2-weighted changes in contiguous bone after radiotherapy may be confused with tumor. Treatment depends on the nature of the underlying tumor and is typically confined to irradiation as previously described.
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Are Headaches Taking Your Life Hostage and Preventing You From Living to Your Fullest Potential? Are you tired of being given the run around by doctors who tell you that your headaches or migraines are psychological or that they have no cause that can be treated? Are you sick of calling in sick because you woke up with a headache so bad that you can barely think or see straight?