Probable cavernous sinus-adjacent meningeal metastasis from esophageal squamous cell carcinoma: A case report

Meningeal dissemination from esophageal squamous cell carcinoma (ESCC) is exceptionally rare, and cavernous sinus-adjacent involvement has been only sparsely described. The present study reports the case of a 59-year-old man with controlled extracranial ESCC who presented with acute oculomotor and trochlear nerve palsies shortly after severe acute respiratory syndrome coronavirus 2 infection. Although the symptoms were initially attributed to post-viral neuropathy, contrast-enhanced magnetic resonance imaging demonstrated multifocal nodular meningeal enhancement and irregular dural thickening adjacent to the cavernous sinus, findings highly suggestive of meningeal metastasis. Cerebrospinal fluid examination and biopsy of the meningeal lesion were not performed; therefore, the diagnosis remained as radiologically supported probable meningeal metastasis from ESCC, and the exact pachymeningeal or leptomeningeal compartment could not be confirsmed. The progression occurred 2 months after resection of a solitary brain metastasis despite sustained extracranial control. This case illustrates sequential parenchymal and probable meningeal central nervous system progression and highlights the risk of anchoring bias when a concurrent viral infection provides an apparently plausible alternative explanation. New focal cranial neuropathies in patients with cancer warrant urgent contrast-enhanced neuroimaging.