Tracking Down the Third Nerve

Diplopia; Left ptosisA 37-year old female with drooping left lid and diplopia. Previous history significant for a prolactinoma Dx when presented at 9-years with vision loss and field defect OS. Tx: RadiotherapyVA: 20/20 OUCT; MRIPoorly-differentiated malignant neoplasm with pleomorphism and mitoses.Antineoplastic agents1. Ron E, Modan B, Boice JD, Alfandary E, Stovall M, Chetrit A, Katz L. Tumors of the brain and nervous system after radiotherapy in childhood. NEJM 1988;319:1033-9. 2. Rimm IJ, Li FC, Tarbell NJ, Winston KR, Sallan SE. Brain tumors after cranial irradiation for childhood acute lymphoblastic leukemia: a 13-year experience from the Dana-Farber Cancer Institute and the Children's Hospital. Cancer 1987;59:1506-8. 3. Kaschten B, Flandroy P, Reznik M, Hainaut H, Stevenaert A. Radiation-induced gliosarcoma: case report and review of the literature. J Neurosurg 1995; 83:154-62. 4. Averback P. Mixed intracranial sarcomas: rare forms and a new association with previous radiation therapy. Ann Neurol 1978;4:229-33. 5. Hufnagel TJ, Kim JH, Lesser R, Miller JM, Abrahams JJ, Piepmeier J, Manuelidis EE. Malignant glioma of the optic chiasm eight years after radiotherapy for prolactinoma. Arch Ophthalmol 1988;106:1701-5. 6. Al-Mefty O, Kersh JE, Routh A, Smith RR. The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 1990;73:502-12. 7. Ghim TT, Seo JJ, O'Brien M, Meachem L, Crocker I, Krawiecki N. Childhood intracranial meningiomas after high-dose irradiation. Cancer 1993;71:4091-5. 8. Strojan P, Popovic M, Jereb B. Secondary intracranial meningiomas after high-dose cranial irradiation: report of five cases and review of the literature. Int J Rad Oncol Biol Phys 2000;48:65-73. 9. Brada M, Ford D, Ashley S, Bliss JM, Crowley S, Mason M, Rajan B, Traish D. Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. BMJ 1992;304:1343-6. 10. Loeffler JS, Niemierko A, Chapman PH. Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurg 2003;52:1436-1442