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Clinical presentationA 67-year-old recurrent uterine cervical cancer patient with left supraclavicular lymph node metastasis presented with one week history of left eyelid drooping. On history taking and examination there was a 3mm ptosis of the left upper eyelid, a smaller left pupil, and left facial hypohidrosis (Figure 1A). Administration of one drop of 0.5% apraclonidine in both eyes resulted in reversal of anisocoria and resolution of ptosis (Figure 1B).Answer and discussionOculosympathetic paresis, also known as Horners syndrome, is a characteristic triad of features which consists mainly of miosis, partial upper eyelid ptosis and facial anhidrosis on the ipsilateral side. It occurs as a result of disease affecting the ipsilateral sympathetic pathway along its course from the hypothalamus to the orbit, and it may also be congenital or iatrogenic.1,2 It should prompt clinicians to investigate vigorously any lesion of the oculosympathetic tract as it may be the manifestation of an important underlying condition such as malignant tumor. Neoplasia is the most common cause and accounts for 35-60% of all cases.3 Figure 1A: Ptosis of the left upper eyelid and a smaller left pupil. Figure 1B: Reversal of anisocoria and resolution of ptosis after administration of one drop of 0.5% apraclonidine in both eyes.

Summary

Abstract

We present a case of reversible diabetes insipidus in a 64-year-old man with multiple myeloma. Central diabetes insipidus developed in association with a myelomatous lesion of the clivus, but without evidence of macroscopic pituitary compression. Resolution of this patients diabetes insipidus was observed following treatment of his myeloma.

Aim

Method

Results

Conclusion

Author Information

Ji Young Moon, Resident, Department of Internal Medicine, Chungnam National University Hospital; Yeon-Hee Lee, Associate Professor, Department of Ophthalmology, Chungnam National University School of Medicine; Hyo Jin Lee, Associate Professor, Chungnam National University School of Medicine, Daejeon 301-721, Republic of Korea

Acknowledgements

Correspondence

Hyo Jin Lee, MD, PhD, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Republic of Korea

Correspondence Email

cymed@cnu.ac.kr

Competing Interests

Nil

- Crevits L, DHerde K, Deblaere K. Painful isolated Horners syndrome caused by pontine ischaemia. Graefes Arch Clin Exp Ophthalmol 2004; 242: 181-3. Mohyudin MN, Arshad FA, Anand N. Horners syndrome as a presenting sign of metastatic testicular malignancy. JRSM Short Rep 2011; 2: 23. Miura J, Doita M, Miyata K, Yoshiya S, Kurosaka M, Yamamoto H. Horners syndrome caused by a thoracic dumbbell-shaped schwannoma: sympathetic chain reconstruction after a one-stage removal of the tumor. Spine 2003; 28: E33-6.-

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Clinical presentationA 67-year-old recurrent uterine cervical cancer patient with left supraclavicular lymph node metastasis presented with one week history of left eyelid drooping. On history taking and examination there was a 3mm ptosis of the left upper eyelid, a smaller left pupil, and left facial hypohidrosis (Figure 1A). Administration of one drop of 0.5% apraclonidine in both eyes resulted in reversal of anisocoria and resolution of ptosis (Figure 1B).Answer and discussionOculosympathetic paresis, also known as Horners syndrome, is a characteristic triad of features which consists mainly of miosis, partial upper eyelid ptosis and facial anhidrosis on the ipsilateral side. It occurs as a result of disease affecting the ipsilateral sympathetic pathway along its course from the hypothalamus to the orbit, and it may also be congenital or iatrogenic.1,2 It should prompt clinicians to investigate vigorously any lesion of the oculosympathetic tract as it may be the manifestation of an important underlying condition such as malignant tumor. Neoplasia is the most common cause and accounts for 35-60% of all cases.3 Figure 1A: Ptosis of the left upper eyelid and a smaller left pupil. Figure 1B: Reversal of anisocoria and resolution of ptosis after administration of one drop of 0.5% apraclonidine in both eyes.

Summary

Abstract

We present a case of reversible diabetes insipidus in a 64-year-old man with multiple myeloma. Central diabetes insipidus developed in association with a myelomatous lesion of the clivus, but without evidence of macroscopic pituitary compression. Resolution of this patients diabetes insipidus was observed following treatment of his myeloma.

Aim

Method

Results

Conclusion

Author Information

Ji Young Moon, Resident, Department of Internal Medicine, Chungnam National University Hospital; Yeon-Hee Lee, Associate Professor, Department of Ophthalmology, Chungnam National University School of Medicine; Hyo Jin Lee, Associate Professor, Chungnam National University School of Medicine, Daejeon 301-721, Republic of Korea

Acknowledgements

Correspondence

Hyo Jin Lee, MD, PhD, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Republic of Korea

Correspondence Email

cymed@cnu.ac.kr

Competing Interests

Nil

- Crevits L, DHerde K, Deblaere K. Painful isolated Horners syndrome caused by pontine ischaemia. Graefes Arch Clin Exp Ophthalmol 2004; 242: 181-3. Mohyudin MN, Arshad FA, Anand N. Horners syndrome as a presenting sign of metastatic testicular malignancy. JRSM Short Rep 2011; 2: 23. Miura J, Doita M, Miyata K, Yoshiya S, Kurosaka M, Yamamoto H. Horners syndrome caused by a thoracic dumbbell-shaped schwannoma: sympathetic chain reconstruction after a one-stage removal of the tumor. Spine 2003; 28: E33-6.-

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Clinical presentationA 67-year-old recurrent uterine cervical cancer patient with left supraclavicular lymph node metastasis presented with one week history of left eyelid drooping. On history taking and examination there was a 3mm ptosis of the left upper eyelid, a smaller left pupil, and left facial hypohidrosis (Figure 1A). Administration of one drop of 0.5% apraclonidine in both eyes resulted in reversal of anisocoria and resolution of ptosis (Figure 1B).Answer and discussionOculosympathetic paresis, also known as Horners syndrome, is a characteristic triad of features which consists mainly of miosis, partial upper eyelid ptosis and facial anhidrosis on the ipsilateral side. It occurs as a result of disease affecting the ipsilateral sympathetic pathway along its course from the hypothalamus to the orbit, and it may also be congenital or iatrogenic.1,2 It should prompt clinicians to investigate vigorously any lesion of the oculosympathetic tract as it may be the manifestation of an important underlying condition such as malignant tumor. Neoplasia is the most common cause and accounts for 35-60% of all cases.3 Figure 1A: Ptosis of the left upper eyelid and a smaller left pupil. Figure 1B: Reversal of anisocoria and resolution of ptosis after administration of one drop of 0.5% apraclonidine in both eyes.

Summary

Abstract

We present a case of reversible diabetes insipidus in a 64-year-old man with multiple myeloma. Central diabetes insipidus developed in association with a myelomatous lesion of the clivus, but without evidence of macroscopic pituitary compression. Resolution of this patients diabetes insipidus was observed following treatment of his myeloma.

Aim

Method

Results

Conclusion

Author Information

Ji Young Moon, Resident, Department of Internal Medicine, Chungnam National University Hospital; Yeon-Hee Lee, Associate Professor, Department of Ophthalmology, Chungnam National University School of Medicine; Hyo Jin Lee, Associate Professor, Chungnam National University School of Medicine, Daejeon 301-721, Republic of Korea

Acknowledgements

Correspondence

Hyo Jin Lee, MD, PhD, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Republic of Korea

Correspondence Email

cymed@cnu.ac.kr

Competing Interests

Nil

- Crevits L, DHerde K, Deblaere K. Painful isolated Horners syndrome caused by pontine ischaemia. Graefes Arch Clin Exp Ophthalmol 2004; 242: 181-3. Mohyudin MN, Arshad FA, Anand N. Horners syndrome as a presenting sign of metastatic testicular malignancy. JRSM Short Rep 2011; 2: 23. Miura J, Doita M, Miyata K, Yoshiya S, Kurosaka M, Yamamoto H. Horners syndrome caused by a thoracic dumbbell-shaped schwannoma: sympathetic chain reconstruction after a one-stage removal of the tumor. Spine 2003; 28: E33-6.-

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