Home
|
Inbox
|
Search
|
View Abstract
Occipital Condyle Syndrome as the Initial Presentation of Lung Cancer
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A4053 - Occipital Condyle Syndrome as the Initial Presentation of Lung Cancer
Author Block: M. Doraiswamy, M. Kamau, A. Jacob, P. Angi; Internal Medicine, Monmouth Medical Center, Long Branch, NJ, United States.
Lung cancer is the most common cancer in men and leading cause of cancer mortality worldwide among women. Approximately 20% of Non-small cell lung cancers (NSCLC) have bone metastasis at presentation. The base of the skull is a less frequent site of metastasis and is most often silent. Occipital Condyle syndrome (OCS) is a rare clinical syndrome, consisting of unilateral occipital headache accompanied by ipsilateral hypoglossal palsy . To the best of our knowledge, this is the fourth reported case of OCS from primary lung cancer. A 55-year-old Asian female with no significant past medical history presented to the emergency room with continuous left sided temporo-occipital headache of one-month duration and difficulty chewing food and deviation of tongue for 5 days. The headache was only partially relieved with over the counter medications. Physical examination revealed mild fasciculation of the tongue with deviation of tongue to right with no atrophy. A Computed Tomography (CT) imaging of the brain was done and was unremarkable. MRI brain was done which revealed 2.0 x 2.7 x 1.2 cm enhancing lesion destroying the right skull base in the region of the right hypoglossal canal. Subsequent screening with CT of the chest, abdomen and pelvis revealed 4.7 cm spiculated mass at the superior segment of the left lower lobe with metastatic lymphadenopathy to left hilar, mediastinal and right supraclavicular. A right adrenal mass and sclerotic lesions in the T9 and L2 vertebral bodies without central canal compromise was found identified as possible metastasis. A CT guided lung biopsy confirmed the diagnosis of adenocarcinoma of lung. Patient was started on Bevacizumab, Pemetrexed , Carboplatin and also received Keytruda with radiation therapy. She was also given a tapering dose of prednisone and the headache resolved in a week. Metastasis or primary tumors involving an occipital condyle can directly invade the skull base involving the hypoglossal canal and result in lower cranial nerves neuropathies. Our patient experienced a unique pattern of a severe, continuous, unilateral pain in the occipital region, with symptoms typically improving by turning the head towards the painful side. Majority of cases remain silent. OCS is characterized by an isolated unilateral hypoglossal paresis and mastoid tenderness along with the headache. Diagnostic imaging of the skull base may appear normal on initial presentation. An awareness of the characteristics of OCS in healthy adults may lead to earlier diagnosis of the underlying etiology and prevent irreversible neurological damage.
Author Block: M. Doraiswamy, M. Kamau, A. Jacob, P. Angi; Internal Medicine, Monmouth Medical Center, Long Branch, NJ, United States.
Lung cancer is the most common cancer in men and leading cause of cancer mortality worldwide among women. Approximately 20% of Non-small cell lung cancers (NSCLC) have bone metastasis at presentation. The base of the skull is a less frequent site of metastasis and is most often silent. Occipital Condyle syndrome (OCS) is a rare clinical syndrome, consisting of unilateral occipital headache accompanied by ipsilateral hypoglossal palsy . To the best of our knowledge, this is the fourth reported case of OCS from primary lung cancer. A 55-year-old Asian female with no significant past medical history presented to the emergency room with continuous left sided temporo-occipital headache of one-month duration and difficulty chewing food and deviation of tongue for 5 days. The headache was only partially relieved with over the counter medications. Physical examination revealed mild fasciculation of the tongue with deviation of tongue to right with no atrophy. A Computed Tomography (CT) imaging of the brain was done and was unremarkable. MRI brain was done which revealed 2.0 x 2.7 x 1.2 cm enhancing lesion destroying the right skull base in the region of the right hypoglossal canal. Subsequent screening with CT of the chest, abdomen and pelvis revealed 4.7 cm spiculated mass at the superior segment of the left lower lobe with metastatic lymphadenopathy to left hilar, mediastinal and right supraclavicular. A right adrenal mass and sclerotic lesions in the T9 and L2 vertebral bodies without central canal compromise was found identified as possible metastasis. A CT guided lung biopsy confirmed the diagnosis of adenocarcinoma of lung. Patient was started on Bevacizumab, Pemetrexed , Carboplatin and also received Keytruda with radiation therapy. She was also given a tapering dose of prednisone and the headache resolved in a week. Metastasis or primary tumors involving an occipital condyle can directly invade the skull base involving the hypoglossal canal and result in lower cranial nerves neuropathies. Our patient experienced a unique pattern of a severe, continuous, unilateral pain in the occipital region, with symptoms typically improving by turning the head towards the painful side. Majority of cases remain silent. OCS is characterized by an isolated unilateral hypoglossal paresis and mastoid tenderness along with the headache. Diagnostic imaging of the skull base may appear normal on initial presentation. An awareness of the characteristics of OCS in healthy adults may lead to earlier diagnosis of the underlying etiology and prevent irreversible neurological damage.
|
Home
|
Inbox
|
Search
|