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Squamous cell carcinoma with perineural invasion presenting as a Tolosa-Hunt-like syndrome: a potential pitfall in
B Esmaeli1, L Ginsberg, H Goepfert
1The Ophthalmology Section, M.D. Anderson Cancer Center Houston, Texas 77030, USA.
Purpose:
To describe a case of perineural invasion resulting from squamous cell carcinoma of forehead.
Methods:
Case report.
Results:
Perineural invasion resulting from squamous cell carcinoma of the periocular skin can present as a Tolosa-Hunt-like syndrome with lack of radiologic findings on magnetic resonance imaging (MRI) in its early stages.
Conclusion:
A high level of suspicion for perineural invasion is required when assessing multiple cranial nerve palsies in patients with a history of cutaneous malignancy, despite negative sequential MRI. Perineural invasion must be ruled out by a biopsy of the involved nerves, whenever possible, before empiric therapy with systemic steroids is contemplated.
