Cavernous sinus syndrome and hepatoma metastasis

A 46-year-old man presented with left cavernous sinus syndrome and subsequent right leg pain proved clear cell type hepatocellular carcinoma metastasis. An initial liver function test was normal and alpha-fetoprotein was only 15 ng/ml but they increased rapidly and he progressed to hepatic failure 2 weeks later. Therefore, a subclinical hepatoma with metastasis should be differentiated in cavernous sinus syndrome, even in cases of normal hepatic enzymes, because hepatoma is prevalent in Taiwan.