title: Squamous cell carcinoma with perineural invasion presenting as a Tolosa-Hunt-like syndrome: a potential pitfall in diagnosis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: The Ophthalmology Section, M.D. Anderson Cancer Center Houston, Texas 77030, USA.
authors: B
authors: B
authors: Esmaeli
authors: L
authors: L
authors: Ginsberg
authors: H
authors: H
authors: Goepfert
authors: M
authors: M
authors: Deavers
mesh_terms: D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis* / Q000532:radiotherapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D005153:Facial Neoplasms / Q000150:complications / Q000473:pathology* / Q000532:radiotherapy; D005546:Forehead; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009915:Orbit / Q000294:innervation*; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000532:radiotherapy; D020333:Tolosa-Hunt Syndrome / Q000150:complications / Q000175:diagnosis*