Question: A 62 year old woman presents with a headache, double vision, and nasal obstruction.  You obtain a maxillofacial CT scan and note a destructive mass which appears to originate from the left sphenoid sinus.  It appears to have invaded into the nasal cavity and through the lateral sphenoid bone and has just started to involve the cavernous sinus.  What extraocular movement pathology would be most likely on your physical exam?

[Answer will be posted with next week's new question]

Answer to last week's question, Don't Sweat It (Jan 24, 2015):

This woman is most likely presenting with a second primary apical lung tumor resulting in Horner's syndrome.  This is also called Pancoast tumor and can involve the brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or sympathetic ganglion (thus the Horner's syndrome).