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Unilateral Fourth Nerve Palsy due to Presumed Metastatic Melanoma
Joshua Pasol1, Eric A Mellon, Lynn G Feun
1Department of Ophthalmology (JP), University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida; Department of Radiation Oncology (EAM, TPD), University of Miami Miller School of Medicine, Miami, Florida; Department of Hematology/Oncology (LGF), University of Miami Miller School of Medicine, Miami, Florida; Department of Radiology (GMS), University of Miami Miller School of Medicine, Miami, Florida; Department of Neurosurgery (RJK), University of Miami Miller School of Medicine, Miami, Florida.
Abstract:
An 81-year-old man with a history of metastatic melanoma presented with sudden onset of painless, binocular vertical diplopia. The clinical examination was consistent with a right fourth nerve palsy. An MRI of the head revealed a mass dorsal to the right tectum at the level of the inferior colliculus. An MRI just 4 months prior did not show a lesion in that location. An MRA of the head did not show an aneurysm. This is a rare case of an isolated fourth nerve palsy believed to be due to metastatic melanoma compressing the nerve along the dorsal midbrain.
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