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

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.