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. 2016:2016:9184501.
doi: 10.1155/2016/9184501. Epub 2016 Mar 15.

Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit

Jerome Okudo  1 , Nwabundo Anusim  2
Affiliations

Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit

Jerome Okudo et al. Case Rep Neurol Med. 2016.

Abstract

Renal cell carcinoma (RCC) has unusual presentation affecting elderly males with a smoking history. The incidence of RCC varies while the incidence of spread of RCC to the clivus is rare. The typicality of RCC presentation includes hematuria, flank pain, and a palpable flank mass; however, RCC can also present with clival metastasis. The unique path of the abducens nerve in the clivus makes it susceptible to damage in metastasis. We report a case of a 54-year-old African American female that was evaluated for back pain, weakness, numbness, and tingling of bilateral lower extremities and subsequently disconjugate gaze and diplopia. Brain MRI confirmed metastasis to the clivus. She was started on radiotherapy and was planned for chemotherapy and transfer to a nursing home. When a patient presents with sudden unusual cranial nerve pathology, the possibility of metastatic RCC should be sought.

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Figures

Figure 1
Figure 1
Sagittal section of the brain without contrast showing the clival lesion.
Figure 2
Figure 2
MRI precontrast showing altered signal intensity of the clivus, axial section that appears hyperintense.
Figure 3
Figure 3
MRI precontrast showing altered signal intensity of the clivus, coronal section that appears hyperintense.
Figure 4
Figure 4
MRI postcontrast showing altered signal intensity of the clivus, axial section that appears heterogeneously hyperintense.
See this image and copyright information in PMC

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