Nasopharyngeal carcinoma: Isolated oculomotor nerve palsy

Squamous cell carcinoma (SCC) is the most prevalent type of Nasopharyngeal carcinoma (NPC), making up 71% of cases. NPC typically presents with a neck mass, often the initial admission cause. Other symptoms include serous otitis, nasal congestion, and bleeding. Rarely, NPC may spread to cranial nerves, affecting nerves IX, X, XI, and XII and potentially extending to nerves III, IV, V, and VI via the Foramen lacerum into the cavernous sinus. This study discusses an unusual NPC case where isolated right Oculomotor nerve palsy was the first symptom in a 69-year-old male experiencing severe headaches and ptosis. Paranasal CT revealed bilateral Sphenoid sinus masses and a fragile, hemorrhagic nasopharyngeal mass on the right. Biopsy identified undifferentiated NPC. This rare case underscores the importance of considering NPC in atypical cranial nerve presentations, where early diagnosis and timely treatment, such as chemoradiotherapy, are crucial for achieving favorable outcomes.