By Dr Cameron Scott
55 year old male presents with progressive diplopia. On examination, patient had a left superior oblique muscle palsy.
Contrast enhanced MRI of the brain.
MRI demonstrates multiple ring enhancing lesions in the brain. The findings are consistent with metastatic disease. There is an 8mm lesion in the right anterior periaqueductal grey matter of the midbrain. This is in the region of the nucleus of the left trochlear nerve (CN IV) and explains the patient’s left superior oblique palsy.
Patient will undergo further cancer work up and treatment.