• Ophthal Plast Reconstr Surg · Nov 2000

    Case Reports

    Squamous cell carcinoma with perineural invasion presenting as a Tolosa-Hunt-like syndrome: a potential pitfall in diagnosis.

    • B Esmaeli, L Ginsberg, H Goepfert, and M Deavers.
    • The Ophthalmology Section, M.D. Anderson Cancer Center Houston, Texas 77030, USA.
    • Ophthal Plast Reconstr Surg. 2000 Nov 1; 16 (6): 450-2.

    PurposeTo describe a case of perineural invasion resulting from squamous cell carcinoma of forehead.MethodsCase report.ResultsPerineural 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.ConclusionA 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.

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