Metastasis to Midbrain from Mammary Carcinoma

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Abstract
ABRUPT ONSET of bilateral ptosis in an elderly patient is usually the result of vascular disease in the brain stem. As far as we can determine, the case to be described is the first published report of such symptoms as initial evidence of metastasis from breast carcinoma. Report of a Case A 66-year-old woman was admitted to Franklin Hospital on Jan 1, 1962, for evaluation of diplopia and bilateral ptosis of abrupt onset some 4 weeks earlier (Fig 1). Two years previously the patient had had a radical mastectomy because of breast carcinoma. Metastases to several axillary lymph nodes were treated postoperatively with deep radiation therapy. There was no further evidence of metastasis. An erratic self-determined schedule of 2 to 3 grains of desiccated thyroid per day was stopped by the patient 3 weeks before the onset of eye symptoms. No members of the patient's family had ptosis. Examination. This

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