| Type of metastases | Signs and symptoms | |
|---|---|---|
| Middle fossa syndrome | Similar to trigeminal neuralgia, i.e., numbness, paresthesia, and pain referred to the second or third divisions of the fifth nerve, except that objective signs of neuropathy, e.g., corresponding sensory deficits and masseter weakness, may be present. Diplopia, dysarthria, headache, and dysphagia may develop as well. | |
| Jugular foramen syndrome | Occipital pain often radiating to the vertex and ipsilateral shoulder or neck; may be accompanied by ocal tenderness and exacerbation with movement of the head. Neurologic signs consistent with dysfunction of cranial nerves IX through XII and Horner's syndrome may be present. Lancinating throat pain (glossopharyngeal neuralgia) has been observed n association with the above symptoms or as the sole complaint. | |
| Clivus metastases | Vertex headache exacerbated by neck flexion; may be accompanied by either unilateral or bilateral cranial nerve dysfunction (IV through XXII). | |
| Orbital metastases | Retro-orbital or frontal headache often with diplopia, visual loss, proptosis, and extraocular nerve palsies. | |
| Parasellar metastases | Symptoms similar to those of orbital metastases. | |
| Sphenoid sinus metastases | Bifrontal headache radiating to both temples with intermittent retro-orbital pain. Nasal stuffiness, diplopia, and a unilateral or bilateral VI cranial nerve palsy may be present. | |
| Occipital condyle invasion | Severe occipital pain that is exacerbated by movement and that may be accompanied by XII cranial nerve dysfunction. | |
| Odontoid fractures | Usually caused by tumor or metastasis to atlas bone. Risk of spinal cord compression due to vertebral instability. |
Source: Adapted from Elliot and Foley, 1989; Greenberg, Deck, Vikram, et al., 1981.