METASTATIC LUNG CARCINOMA PRESENTED AS ISOLATED LOWER MOTOR NEURON-TYPE FACIAL NERVE PALSY AND BILATERAL ABDUCENS NERVE PALSY WITH ABSENT OF TYPICAL LUNG SYMPTOMS - A RARE CLINICAL PHENOMENON

Medicine

When a patient presents with simultaneous abducens nerve paralysis in both eyes and unilateral facial nerve paralysis, we consider potential brain stem disorders such as infection, vascular issues, demyelination, and neoplastic causes. Lung cancer, a common and highly fatal malignancy, frequently spreads to various body parts. Specifically, lung adenocarcinoma tends to metastasize to the liver, adrenal glands, brain, and bones. Brain metastases occur in approximately 10.4% of non-small cell lung carcinoma (NSCLC) cases, usually showing up incidentally or through seizures. Here we describe the case of a 46-year-old woman who had been diagnosed with left-sided Bell's palsy two months prior and sought neurological attention due to experiencing double vision during lateral gaze for the past two months. Upon examination, subtle paralysis of the abducens nerve (CN VI) in both eyes and lower motor neuron facial nerve (CN VII) paralysis on the left side were observed. Magnetic resonance imaging (MRI) revealed multiple metastases in both cerebral and cerebellar hemispheres. Further malignancy screening, including Contrast Enhanced Computed Tomography (CECT) of the chest, abdomen, and pelvis, identified an enhancing soft tissue mass in the right lower lung lobe, suggestive of a primary neoplastic lesion. Biopsy confirmed the presence of lung adenocarcinoma. The patient was referred to an oncologist and received intracranial irradiation and chemotherapy. This case is notable because the patient with lung carcinoma presented with isolated bilateral abducens nerve paralysis and unilateral facial nerve paralysis as initial symptoms, without respiratory complications.

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