An unusual case of third cranial nerve palsy

Abstract

62 year old man presented with complaints of drooping of right upper eyelid for 15 days. It was associated with headache , eye pain , diplopia on retracting the eyelid. No history of any systemic diseases or trauma. On ocular examination , best corrected visual acuity in both eyes was 6 on 6 with N6 near vision and normal intraocular pressure . The anterior segment examination of right eye showed  complete ptosis , mid dilated pupil with gross restriction of extraocular movements except for abduction.Corneal  sensation was slightly reduced in right eye. Anterior segment examination of left eye was normal.Investigations revealed right third cranial nerve palsy . Considering the clinical red flag signs , MRI Brain was done which revealed extra axial lesion involving infra temporal and pterygo palatine fossa and spreading perineurally throught 5th cranial nerve into right cavernous sinus affecting 3rd cranial nerve. A radiological diagnosis of Adenoid cystic carcinoma of minor salivary glands was made.