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| GRAND ROUND CASE |
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| Year : 2021 | Volume
: 67
| Issue : 2 | Page : 96-99 |
Unraveling a cephalalgic quagmire from a cavern to a cave
S Thenmozhi1, S Girija1, KN Viswanathan1, KV Karthikeyan2
1 Department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
2 Department of Neurosurgery, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India
Correspondence Address:
S Girija
Department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jpgm.JPGM_809_20
Headache in women in their late forties can be primary or secondary. We report a 48-year-old female with chronic slowly progressive left temporal headache for 1 year. She also had ipsilateral eye pain and facial numbness for 1 month, with restricted abduction in the left eye and diplopia. On neurological examination, she had isolated left abducent nerve palsy, with loss of corneal and conjunctival reflexes, localizing the pathology to the cavernous sinus or its adjacent structures. Anatomically, cranial nerves V and VI are in close proximity to each other in the region of Meckel's cave. In view of her age, insidious onset, progressive symptoms and clinical findings, the provisional diagnosis in this patient was a Meckel's cave tumor. Magnetic resonance (MR) imaging revealed a 2 cm × 2 cm × 1.7 cm enhancing dumb-bell-shaped mass lesion with mild restricted diffusion in the Meckel's cave projecting into cavernous sinus with alanine, myoinositol and glutamine peaks on MR spectroscopy. Intradural debulking was done; lesion was confirmed by histopathology and patient was cured of her symptoms. An algorithm for diagnosing this entity at the bedside is presented.
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