Diplopia and diarrhea: ileal carcinoid metastatic to the central nervous system

The case of a patient with metastatic ileal carcinoid is reported. The peculiarities of this case were as follows: 1) The patient presented with symptoms attributable to a mass lesion in the brain which was proven to be a carcinoid tumor by biopsy. 2) The patient had symptoms attributable to carcinoid syndrome without radiologic evidence of hepatic metastasis. 3) No bony or pulmonary metastasis was evident, which suggests that the metastatic spread from the ileum occurred through the spinous venous plexus of Batson. The patient's symptoms were managed with cyproheptadine with good effect. A review of the carcinoid syndrome and the determinants of its metastatic spread is presented.