An unusual complication of prostatic bony metastases
© International Cancer Imaging Society 2003
Accepted: 5 November 2002
Published: 5 May 2015
Carcinoma of the prostate is a common condition and often spreads to bone. We describe the imaging findings in two patients with known carcinoma of the prostate who presented with visual disturbance (both had papilloedema on examination). MRI showed occipital bone metastases and superior sagittal sinus thrombosis. We suggest that MRI is the imaging modality of choice in patients suffering from prostate cancer who have visual disturbance and that MRV sequences should be included to detect venous sinus thrombosis.
KeywordsProstate bone metastases sinus thrombosis visual disturbance
Carcinoma of the prostate is a common condition, with over 21 000 cases and over 10 000 deaths every year in the United Kingdom alone. The disease often spreads to bone. We describe two patients with known carcinoma of the prostate who presented with visual disturbance and papilloedema on examination. Imaging showed occipital bone metastases and superior sagittal sinus thrombosis.
The second patient was a 62-year-old gentleman who was admitted to hospital with a history of recent onset of headaches, nausea, nocturia and macroscopic haematuria. His general practitioner had measured his PSA, which was 371 µg/l. Positive findings on examination included bilateral papilloedema and a markedly ataxic gait with cerebellar ataxia.
The patient was commenced on cyproterone acetate and received 30 Gy to the skull in 10 fractions over 14 days. He showed a good response to treatment.
Bony metastases are common in prostate carcinoma. Papilloedema has been described in prostate carcinoma due to transverse sinus thrombosis, but this was a result of dural metastases at the torcula and not in the bone of the skull vault. Bony metastases in the optic canal have also been described, causing painless visual loss.
Bony metastases may respond well to radiotherapy and hormonal treatment. MRI is effective at showing both bony metastases in carcinoma of the prostate and is the imaging modality of choice for cerebral venous sinus thrombosis. Intravenous contrast-enhanced CT scanning may show filling defects in the superior sagittal sinus, but MRI is more sensitive in the detection of superior sagittal thrombosis and venous oedema and of bone metastases. MRI does not suffer from the bone artefacts in the posterior fossa.
We would suggest that in a patient with visual disturbance, who is known to be suffering from a malignancy that may spread to bone, MRI is the imaging modality of choice and the venous sinuses should be examined with MRV at the time of imaging.
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