PMC9149351_01
Patient with complete left blepharoptosis 1 week after the first dose of pembrolizumab.
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F1
However, 1 week after the first dose, she complained of painless, progressive, left eyelid ptosis, which was unresponsive to the ice-pack test (Fig. 1).
T2-weighted MRIs of the patient. a Normal eyes' alignment after removal of left cerebellar metastasis. b Patient complaining diplopia and recurrent left cerebellar metastasis before second surgical treatment (80 days after first surgical resection). The image shows eyes' misalignment due to left III cranial nerve palsy (asterisk), the recurrent left cerebellar metastasis but no other pathological tissue or mesencephalic alterations. c After second surgical treatment (100 days after first surgical resection), eyes' misalignment and left III cranial nerve palsy persist.
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F2
A follow-up contrast MRI revealed the absence of vascular lesions on DWI, T2* imaging and FLAIR, a metastasis recurrence in the same cerebellar location, but no lesion in the left oculomotor nucleus or third cranial nerve and no orbital abnormality (Fig. 2a-c).