Prostate cancer metastatic to the planum sphenoidale presenting as sequential bilateral vision loss

Abstract

Metastasis to the anterior cranial fossa from solid tumors is very unusual. We describe a 72-year-old male with history of locally advanced prostate cancer who presented with sequential bilateral vision loss, initially misdiagnosed and mistreated as giant cell arteritis. Neuroimaging eventually revealed an extra-axial soft tissue mass in the planum sphenoidale exerting a pressure effect on the cisternal segments of the optic nerves. He underwent surgical excision of the mass to try to improve his vision. Biopsy results confirmed high grade metastatic adenocarcinoma of the prostate. He was started on high dose glucocorticoids and radiation therapy and his visual symptoms improved. Patients with metastatic prostate cancer can develop cranial nerve deficits secondary to metastatic involvement of the skull base. Early recognition and appropriate therapy is essential to prevent permanent neurological impairment.