Diagnostic Challenge: Sequential Unilateral Cranial Neuropathies Due to Perineural Spread of Carcinoma

ABSTRACT

An 86-year old man developed sequential dysfunction of trigeminal (V1), facial, abducens, trigeminal (v2), oculomotor, and hypoglossal cranial nerves on the right over 20 months. Magnetic resonance imaging (MRI) showed a lesion in the right cavernous sinus. Although there was clinical suspicion that this was related to perineural spread of an extracranial tumour, a primary lesion was not discovered. Stereotactic biopsies of the intracranial lesion were non-diagnostic, and the patient succumbed to his tumour following a period of rapid growth. Postmortem examination showed the intracranial lesion to be a carcinoma with squamous features. This case highlights the challenges of diagnosis of intracranial perineural spread and the potential for transformation from indolent to aggressive tumour behaviour.

KEYWORDS:

• Carcinoma
• cranial neuropathies
• perineural spread

Acknowledgements

The authors thank William Porter, MD, for his assistance preparing the pathology images.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This study was supported by grant K23 EY-024345 (to H.M.), an unrestricted grant from Research to Prevent Blindness to the University of Illinois at Chicago Department of Ophthalmology and Visual Sciences, and an unrestricted grant from Research to Prevent Blindness to the Stanford University Department of Ophthalmology.

Additional information

Funding

This study was supported by grant K23 EY-024345 (to H.M.), an unrestricted grant from Research to Prevent Blindness to the University of Illinois at Chicago Department of Ophthalmology and Visual Sciences, and an unrestricted grant from Research to Prevent Blindness to the Stanford University Department of Ophthalmology.