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Presentation type	E-poster
Title	A Rare Ocular Manifestation of Undiagnosed Prostatic Adenocarcinoma: A Case Report

Purpose	In elderly patients, abducens nerve palsy is often attributed to a microvascular origin. However, severe pain, involvement of other cranial nerves, and a progressive course should lead further investigation for a secondary cause. We report an unusual case of painful diplopia revealing metastatic involvement of the cavernous sinus
Methods	Anamnesis revealed progressive diplopia followed by trigeminal nerve involvement progressing from V2 to V3, along with decreased vision. A full work-up was performed, including extensive blood tests, brain MRI, PET-CT, and open-sky brain biopsy
Results	MRI showed an infiltrative, non-inflammatory lesion of the cavernous sinus, along with one additional lesion in frontal lobe. Biopsy of the frontal masse revealed a metastasic disease from an initially unknown primary malignancy. Eventually, the etiological work-up identified multi-metastatic prostate cancer with cerebral and orbital involvement extending through the cavernous sinus.
Conclusion	Progressive, severely painful associated with multiple cranial nerve palsies should raise suspicion of cavernous sinus involvement. In this case, Tolosa-Hunt syndrome is the most classic differential diagnosis. However, the infiltrativ lesion showed no inflammatory granuloma expected in Tolosa-Hunt syndrome. Compressive and infectious etiologies are less common while cavernous sinus metastases are rare, accounting for less than 1% of cancer patients. The primary tumors most frequently associated with cavernous sinus metastases include breast, lung, and genitourinary cancers, with prostate cancer being a particularly uncommon but recognized cause.
Conflict of interest	No

Authors 1

Last name	COUTEL
Initials	M
Department	CUSL
City	Bruxelles

Authors 2

Last name	Dubois
Initials	AD
Department	UCL
City	Bruxelles