{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T04:36:57Z","timestamp":1772080617638,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,9,25]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:p>The combination of a sixth nerve palsy and ipsilateral Horner\u2019s syndrome localises the disease process to the posterior cavernous sinus and can be a result of various pathologies in this region. A 74-year-old Chinese woman presented with a 9-month history of binocular horizontal diplopia worse when looking left. She was found to have a left sixth nerve palsy and Horner\u2019s syndrome and MRI revealed an enhancing soft tissue mass in the nasopharynx with involvement of the bones of the skull base and invasion of the left cavernous sinus. Endoscopic biopsy of the mass confirmed the diagnosis of non-keratinising squamous cell carcinoma, which was Epstein-Barr virus positive. She was treated with radiation therapy. Patients with a sixth nerve palsy and ipsilateral Horner\u2019s syndrome should have urgent neuroimaging with careful attention to the cavernous sinus since sympathetic fibres join the sixth nerve for a short distance in this location.<\/jats:p>","DOI":"10.1136\/bcr-2019-232291","type":"journal-article","created":{"date-parts":[[2019,10,11]],"date-time":"2019-10-11T08:05:28Z","timestamp":1570781128000},"page":"e232291","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Nasopharyngeal carcinoma presenting as a sixth nerve palsy and Horner\u2019s syndrome"],"prefix":"10.1136","volume":"12","author":[{"given":"Hatim","family":"Batawi","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4911-9152","authenticated-orcid":false,"given":"Jonathan A","family":"Micieli","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,10,10]]},"reference":[{"key":"2025082802231898000_12.10.e232291.1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/ar.1091910207","article-title":"Sympathetic connections to the fifth and sixth cranial nerves","volume":"191","author":"Parkinson","year":"1978","journal-title":"Anat Rec"},{"key":"2025082802231898000_12.10.e232291.2","first-page":"221","article-title":"Horner syndrome and others?","volume":"11","author":"Mitchell","year":"1979","journal-title":"Surg Neurol"},{"key":"2025082802231898000_12.10.e232291.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.nic.2007.11.003"},{"key":"2025082802231898000_12.10.e232291.4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.sjopt.2014.09.010","article-title":"Sixth nerve palsy + ipsilateral Horner's Syndrome = Parkinson's Syndrome","volume":"29","author":"Ebner","year":"2015","journal-title":"Saudi J Ophthalmol"},{"key":"2025082802231898000_12.10.e232291.5","doi-asserted-by":"publisher","DOI":"10.1016\/0090-3019(81)90116-6"},{"key":"2025082802231898000_12.10.e232291.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-225842","article-title":"Neuro-ophthalmological presentation of giant intracavernous carotid artery aneurysm in a child","volume":"11","author":"Bu\u00f1o","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025082802231898000_12.10.e232291.7","doi-asserted-by":"publisher","DOI":"10.3109\/08820538.2010.541321"},{"key":"2025082802231898000_12.10.e232291.8","doi-asserted-by":"crossref","first-page":"e653","DOI":"10.1097\/SCS.0000000000002131","article-title":"Abducens nerve palsy and ipsilateral Horner syndrome in a patient with carotid-cavernous fistula","volume":"26","author":"Kal","year":"2015","journal-title":"J Craniofac Surg"},{"key":"2025082802231898000_12.10.e232291.9","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1016\/j.jcjo.2019.02.003","article-title":"Abducens nerve palsy and ipsilateral Horner syndrome as the presenting finding of carotid cavernous fistula","volume":"54","author":"Zhuang","year":"2019","journal-title":"Can J Ophthalmol"},{"key":"2025082802231898000_12.10.e232291.10","first-page":"223","article-title":"Cavernous sinus infection manifested by Horner's syndrome and ipsilateral sixth nerve palsy","volume":"7","author":"Hartmann","year":"1987","journal-title":"J Clin Neuroophthalmol"},{"key":"2025082802231898000_12.10.e232291.11","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1038\/sj.eye.6701451","article-title":"Horner's syndrome and sixth nerve palsy due to herpes zoster ophthalmicus arteritis","volume":"19","author":"Pandey","year":"2005","journal-title":"Eye"},{"key":"2025082802231898000_12.10.e232291.12","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.2169\/internalmedicine.48.2319","article-title":"Combination of abducens nerve palsy and ipsilateral postganglionic Horner syndrome as an initial manifestation of uterine cervical cancer","volume":"48","author":"Tsuda","year":"2009","journal-title":"Intern Med"},{"key":"2025082802231898000_12.10.e232291.13","doi-asserted-by":"crossref","first-page":"851","DOI":"10.2169\/internalmedicine.45.1598","article-title":"Abducens nerve palsy and postganglionic Horner syndrome with or without severe headache","volume":"45","author":"Tsuda","year":"2006","journal-title":"Intern Med"},{"key":"2025082802231898000_12.10.e232291.14","first-page":"1","article-title":"Unilateral abducens nerve palsy with ipsilateral Horner\u2019s syndrome as an initial manifestation of recurrent nasopharyngeal carcinoma","volume":"11","author":"Top Karti","year":"2019","journal-title":"Neuro-Ophthalmology"},{"key":"2025082802231898000_12.10.e232291.15","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3341\/kjo.2011.25.6.459","article-title":"Horner's syndrome with abducens nerve palsy","volume":"25","author":"Kang","year":"2011","journal-title":"Korean J Ophthalmol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232291","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:23:31Z","timestamp":1756373011000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":15,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10,10]]},"published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1136\/bcr-2019-232291"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232291","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]}}}