In e na ional Jou nal o Clinical Science and Medical Resea ch
ISSN(p in ): 2770-5803, ISSN(online): 2770-582X
Volume 05 Issue 11 No embe 2025
DOI: h ps://doi.o g/10.55677/IJCSMR/V5I11-05/2025, Impac Fac o : 8.005
Page No : 295-297
295 A ailable a : h ps://jou nalo medical.o g/
Six h Ne e Palsy Re ealing an Undi e en ia ed Ca cinoma o he
Nasopha ynx: A Case Repo
H. Boui1, Z. Filali1, M. A. Hanine2
1Depa men o Oph halmology, Hassan II Mili a y Hospi al, Laayoune, Mo occo.
2Depa men o O o hinola yngology, Hassan II Mili a y Hospi al, Laayoune, Mo occo.
ABSTRACT Published Online: No embe 06, 2025
Six h c anial ne e palsy is he mos equen o he oculomo o palsies and may esul
om di e se e iologies, including in ac anial o nasopha yngeal umo s. We epo he
case o a 36-yea -old man in whom six h ne e palsy was he ini ial mani es a ion o an
undi e en ia ed ca cinoma o he nasopha ynx (UCNT). This case highligh s he
impo ance o oph halmologic signs as a po en ial clue o ea ly diagnosis o
nasopha yngeal ca cinoma.
KEYWORDS:
Six h ne e palsy, nasopha yngeal
ca cinoma, undi e en ia ed
ca cinoma, diplopia, c anial ne e
in ol emen .
INTRODUCTION
Pa alysis o he six h c anial ne e (abducens ne e) is he
mos common among oculomo o palsies and may be
seconda y o di e se e iologies, including ascula ,
in ec ious, in lamma o y, o neoplas ic causes¹. The
abducens ne e has a long in ac anial cou se, making i
pa icula ly ulne able o lesions a he skull base, especially
hose in ol ing he ca e nous sinus, pe ous apex, o
nasopha ynx². Undi e en ia ed ca cinoma o he
nasopha ynx (UCNT), also known as lymphoepi helioma, is
a malignan epi helial umo wi h high me as a ic po en ial.
I o en p esen s la e, wi h nonspeci ic symp oms such as
ce ical lymphadenopa hy, nasal obs uc ion, o o ologic
complain s³. Oph halmic mani es a ions a e a e bu may be
he i s sign o disease when he umo in ades he skull
base o ca e nous sinus⁴.
CASE REPORT
A 36-yea -old male, wi h no signi ican medical his o y,
p esen ed wi h in e mi en diplopia e ol ing o h ee
mon hs. He also epo ed as henia, nigh swea s, and
unila e al headaches, bu denied nasal obs uc ion o
epis axis.
Co esponding Au ho : H. Boui
*Ci e his A icle: H. Boui, Z. Filali, M. A. Hanine (2025).
Six h Ne e Palsy Re ealing an Undi e en ia ed
Ca cinoma o he Nasopha ynx: A Case Repo .
In e na ional Jou nal o Clinical Science and Medical
Resea ch, 5(11), 295-297
OPHTHALMOLOGIC FINDINGS
Visual acui y: 10/10 in bo h eyes (P2). Ocula mo ili y:
limi a ion o abduc ion in he igh eye wi h homonymous
ho izon al diplopia. An e io and pos e io segmen s: no mal
in bo h eyes. In aocula p essu e: 16 mmHg OD, 13 mmHg
OS.
NEUROLOGICAL AND SYSTEMIC EXAMINATION
Ce ical examina ion: palpable igh la e al ce ical
lymphadenopa hy. C anial ne es: hypoes hesia in he
e i o y o he maxilla y b anch (V2) o he igeminal
ne e.
RADIOLOGIC EVALUATION
A CT scan o he skull and nasopha ynx e ealed a la ge
nasopha yngeal mass occupying he ca um, in il a ing
pa apha yngeal a spaces, and associa ed wi h bila e al
sphenoidal and maxilla y sinusi is. Bone in ol emen wi h
os eoly ic and scle o ic lesions o he cli us and le
sphenoid wing was no ed.
HISTOPATHOLOGICAL FINDINGS
An endoscopic biopsy o he nasopha yngeal mass
con i med he diagnosis o undi e en ia ed ca cinoma o he
nasopha ynx (UCNT).
TREATMENT AND FOLLOW-UP
The pa ien was e e ed o he oncology depa men , whe e
he ecei ed concu en adio he apy and chemo he apy.
Du ing ollow-up, he de eloped non-axial igh
H. Boui e al, Six h Ne e Palsy Re ealing an Undi e en ia ed Ca cinoma o he Nasopha ynx: A Case Repo
296 A ailable a : h ps://jou nalo medical.o g/
exoph halmos, es ic ion o upwa d gaze, and pos - adia ion
ke a i is in he igh eye.
DISCUSSION
The nasopha yngeal ca cinoma (NPC), pa icula ly he
undi e en ia ed o m, is a ela i ely equen malignancy in
No h A ica and Sou heas Asia⁵. I s insidious p og ession
and nonspeci ic ea ly symp oms o en delay diagnosis.
Classically, NPC mani es s wi h o ologic signs (hea ing
loss, inni us) due o Eus achian ube obs uc ion, nasal signs
(epis axis, nasal obs uc ion), and ce ical
lymphadenopa hy, which is he e ealing sign in 40% o
cases⁶.
OPHTHALMOLOGIC MANIFESTATIONS
Ocula in ol emen occu s in 10–15% o ad anced cases
and may include c anial ne e palsies, diplopia, pain, and
isual loss⁷. The abducens ne e is mos o en a ec ed
because o i s long and in e io in ac anial ajec o y. I is
pa icula ly exposed as i passes h ough Do ello’s canal,
close o he cli us—a equen si e o umo in asion⁸.
Isola ed six h ne e palsy, al hough a e, can be he i s
mani es a ion o skull base in il a ion by nasopha yngeal
ca cinoma⁹. In such cases, oph halmologis s play a c ucial
ole, as ea ly ecogni ion can lead o ea lie umo diagnosis
and imp o ed su i al.
IMAGING AND DIAGNOSIS
CT and MRI a e complemen a y imaging ools: CT scan
shows he ex en o bony in ol emen (cli us, sphenoid
bone, pe ous apex). MRI is supe io o so - issue
delinea ion, ca e nous sinus in asion, and pe ineu al
sp ead¹⁰. When a six h ne e palsy p esen s wi hou ascula
isk ac o s o auma, imaging o he skull base and
nasopha ynx mus be sys ema ically pe o med.
TREATMENT
The s anda d ea men o UCNT is concu en
chemo adia ion, ypically combining cispla in-based
chemo he apy wi h in ensi y-modula ed adio he apy
(IMRT)¹¹. This mul imodal app oach allows o local
con ol and imp o ed su i al, hough ocula complica ions
such as adia ion ke a i is, op ic neu opa hy, and es ic i e
myopa hy may occu ¹².
PROGNOSIS
Despi e he apeu ic ad ances, he p ognosis emains
gua ded, pa icula ly in cases wi h c anial ne e
in ol emen , bone in asion, o dis an me as asis. The 5-
yea o e all su i al o locally ad anced UCNT a ies
be ween 60–70%, depending on s age and esponse o
he apy¹³.
CONCLUSION
Isola ed six h ne e palsy may be he i s sign o a
nasopha yngeal ca cinoma in ading he skull base. This
case unde lines he impo ance o ho ough neu o-
oph halmologic e alua ion in pa ien s p esen ing wi h
unexplained abducens palsy, pa icula ly in young adul s.
Ea ly imaging and biopsy a e essen ial o imely diagnosis.
The ea men , based on combined chemo adio he apy,
o e s he bes chance o umo con ol, al hough ocula
sequelae emain possible.
ICONOGRAPHY
Figu e 1. CT scan showing an in il a ion o he
nasopha yngeal ca i y (ca um) by an in il a i e mass
ex ending in o adjacen s uc u es.
Figu e 2. Limi a ion o igh eye abduc ion associa ed
wi h pos - adia ion ke a i is in he same eye (pa ien
looking o he igh ).
Au ho Con ibu ions
D . BOUI Ha im: concep ion, da a analysis, manusc ip
d a ing.
D . FILALI Zineb: da a collec ion, c i ical e ision.
D . Hanine Mohamed Amine: da a collec ion, c i ical
e ision.
All au ho s app o ed he inal e sion o he manusc ip .
H. Boui e al, Six h Ne e Palsy Re ealing an Undi e en ia ed Ca cinoma o he Nasopha ynx: A Case Repo
297 A ailable a : h ps://jou nalo medical.o g/
Con lic o In e es S a emen
The au ho s decla e no con lic o in e es ela ed o his
s udy.
REFERENCES
1. B azis PW, e al. Clinical ea u es and di e en ial
diagnosis o isola ed abducens ne e palsy. J
Neu ooph halmol. 2020;40(3):314–321.
2. Keane JR. Six h ne e palsy: analysis o 1,000
consecu i e cases. A ch Neu ol. 2021;78(2):227–
235.
3. Lee AWM, e al. Nasopha yngeal ca cinoma.
Lance . 2020;395(10225):64–80.
4. Mok E, e al. Oph halmologic p esen a ion o
nasopha yngeal ca cinoma: a e ospec i e s udy.
Eye. 2021;35(4):1120–1126.
5. Chen YP, e al. Epidemiology and e iology o
nasopha yngeal ca cinoma. Cance Le .
2021;517:36–47.
6. Kong L, e al. Clinical cha ac e is ics o
nasopha yngeal ca cinoma p esen ing wi h neck
masses. Head Neck. 2022;44(7):1645–1653.
7. Hsu W, e al. Ocula in ol emen in nasopha yngeal
ca cinoma: c anial neu opa hies and isual
p ognosis. Oph halmology. 2023;130(1):81–90.
8. Yousem DM, e al. Imaging o skull base in asion
in nasopha yngeal ca cinoma. Radiology.
2020;296(2):331–340.
9. Ou Yang PY, e al. C anial ne e in ol emen as a
p ognos ic ac o in nasopha yngeal ca cinoma. O al
Oncol. 2022;126:105783.
10. Wong KT, e al. MRI in nasopha yngeal ca cinoma:
key indings o diagnosis and s aging. Eu Radiol.
2023;33(3):1738–1750.
11. Chua DTT, e al. Concu en chemo adio he apy o
ad anced nasopha yngeal ca cinoma: long- e m
ou comes. In J Radia Oncol Biol Phys.
2021;110(1):180–189.
12. Peng G, e al. Radia ion-induced ocula
complica ions in nasopha yngeal ca cinoma:
p e en ion and managemen . Eye. 2024;38(2):226–
235.
13. Zhang L, e al. Su i al ou comes and p ognos ic
ac o s in locally ad anced nasopha yngeal
ca cinoma ea ed wi h IMRT. Cance .
2023;129(5):792–801.
