Bilateral ophthalmoplegia due to symmetric cavernous sinus metastasis from gastric adenocarcinoma

We report a patient with rapidly progressive bilateral total ophthalmoplegia due to bilateral cavernous sinus metastasis from gastric adenocarcinoma. Among a variety of differential diagnoses, etiology of oculomotoric disorders and ophthalmoplegia includes the affection of the cranial nerves III, IV, and VI in the cavernous sinus. Unilateral metastasis in the cavernous sinus occurs quite frequently, however, a bilateral tumor infiltration of both cavernous sinus is extremely rare. Our patient impressively demonstrates the relevance of this differential diagnosis of bilateral ophthalmoplegia. Repeated CCTs and cMRIs were required to find the diagnosis and finally start a therapy, demonstrating that even with advanced neuroradiological techniques, repetition of imaging within short intervals can be necessary to detect rapidly developing metastatic infiltrations as early as possible.