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A case of diplopia masquerading as ptosis: Unveiling a hidden clival chordoma
Neslihan Sevimli1, Güneş Taydaş1, Beril Aycan Yağız1
1Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey.
Abstract:
IntroductionChordomas are malignant tumours derived from residual notochord tissue. They are characterized by slow growth and local aggressiveness. Visual symptoms commonly arise from the compression of neighbouring structures.Case DescriptionThe authors describe a 77-year-old male patient who presented with ptosis following cataract surgery. The patient described diplopia and limitations in all directions. Computed tomography imaging revealed a soft tissue mass The pathology report showed a diagnosis of chordoma. The lesion was surgically removed. Six months postoperatively, ptosis surgery was performed.ConclusionsThis case underscores the correlation between skull base tumours such as chordomas and ocular manifestations, emphasizing the critical importance of thorough evaluation in patients with ptosis before undergoing surgery.
Insights
Chordomas, rare skull base tumors, can cause visual symptoms like ptosis and diplopia. Early diagnosis and evaluation are crucial for managing these ocular manifestations.
Area of Science:
- Neuro-oncology
- Ophthalmology
- Pathology
Background:
- Chordomas are rare, slow-growing malignant tumors originating from notochordal remnants.
- Skull base chordomas can present with diverse neurological and visual symptoms due to mass effect.
- Ocular manifestations, including ptosis and diplopia, are significant indicators of potential skull base pathology.
Purpose of the Study:
- To report a case of chordoma presenting with visual disturbances.
- To highlight the association between skull base tumors and ocular symptoms.
- To emphasize the importance of comprehensive pre-operative evaluation for ptosis.
Main Methods:
- Case report of a 77-year-old male with new-onset ptosis and diplopia.
- Diagnostic imaging including computed tomography (CT) to identify a soft tissue mass.
- Surgical resection of the lesion and histopathological diagnosis of chordoma.
Main Results:
- Computed tomography revealed a soft tissue mass consistent with a skull base tumor.
- Histopathology confirmed the diagnosis of chordoma.
- The patient underwent surgical removal of the tumor, followed by ptosis surgery six months later.
Conclusions:
- This case illustrates a direct correlation between skull base chordomas and ocular symptoms.
- Thorough ophthalmological evaluation is essential in patients presenting with ptosis, especially before surgical intervention.
- Prompt diagnosis and management of chordomas can prevent or alleviate visual complications.
