Worsening Neurological Symptoms in an Older Man With History of Rectal Cancer

By TONY TALEBI, MD, ANNE V. HERDMAN, MD, SANDRA NARAYANAN, MD, ALBERTO MONTERO, MD, and JOHN KAUH, MD — Emory University School of Medicine | June 30, 2010

Dr Talebi is a hematology/oncology fellow, Dr Herdman is pathology attending physician, and Dr Narayanan is neuroradiology attending physician in the department of hematology/oncology at Emory University School of Medicine in Atlanta.
Dr Montero is assistant professor of oncology at the University of Miami Hospital.
Dr Kauh is assistant clinical professor of hematology/oncology in the department of hematology/oncology at Emory University School of Medicine.

A 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.

Audiometric evaluation demonstrates profound hearing loss with no identifiable thresholds in all frequencies, absent reflexes, and absent otoacoustic emissions.

Findings on a CT scan of the head are unremarkable. MRI scans of the brain with gadolinium reveal enhancement along the meningeal surfaces of the right optic nerve and to a lesser degree of the left optic nerve (A), and expanded cranial nerves VII and VIII bilaterally (B). No evidence of hydrocephalus, intraparenchymal mass, or stroke is present.

Based on the clinical picture and MRI findings, what would you include in the differential?

Answer on Next Page

Pages: 1 2

by Marie Poulin | August 03, 2010 9:53 PM EDT

Glioma

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Worsening Neurological Symptoms in an Older Man With History of Rectal Cancer

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