Undiagnosed Squamous Cell Carcinoma of the Forehead Presenting as a Tolosa-Hunt Syndrome

Enriquez, Jose Nieto; Jiménez, Raquel; Redecilla, Pere Huguet

doi:10.3109/09553000902925066

Cited by 9 publications

(3 citation statements)

References 7 publications

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“… Presence of additional systemic features 26 44 45 46 47 48 49 50 51 Other neurological deficits 52 53 54 Evidence of immune suppression or previous malignancy 55 56 57 58 59 60 61 62 63 Atypical features on MRI including nonenhancement on contrast 45 51 53 63 64 65 Involvement of mandibular or maxillary division of trigeminal (THS is primarily an inflammation of anterior CS) 28 44 Failure of resolution clinically/on MRI 26 28 46 53 66 Severe vision loss. 26 …”

Section: R Esultsmentioning

confidence: 99%

Tolosa–Hunt Syndrome

Dutta

Anand

2021

Journal of Current Ophthalmology

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Purpose: To review the diagnostic criteria for Tolosa–Hunt syndrome (THS) and utility of recent modifications. Methods: We searched PubMed for keywords Tolosa Hunt and magnetic resonance imaging. We compared the three editions of International Classification of Headache Disorders and isolated case reports and case series with the assessment of cavernous internal carotid artery (ICA) caliber to find the prevalence of vascular anomalies. We also evaluated cases of THS with the involvement of extracavernous structures and the possible role of idiopathic hypertrophic pachymeningitis (HP). Cases diagnosed falsely as THS were also reviewed for the presence of atypical features and relevance of criterion D. We assessed nonconforming cases (those with normal neuroimaging benign THS) and idiopathic inflammatory orbital pseudotumor (IIPO). Results: Vascular abnormalities were found in 36.36% of THS cases. Benign THS may also show changes in ICA caliber. Evidence suggestive of idiopathic HP could be found in 57% of cases with the involvement of extracavernous structures, such as facial nerve and pituitary gland. Both THS and IIPO are steroid-responsive pathologies with similar clinical and radiological features. False-positive diagnosis of THS results from early labeling, based solely on clinical features and symptom resolution after steroid therapy. Conclusions: Benign THS may be a result of limitation of resolution of available neuroimaging technique or early testing. Early and late vascular changes can be seen in both THS and its benign variant; some of them are not innocuous. THS may be considered a type of focal idiopathic HP. IIPO may represent an anterior variant of THS. In the absence of histopathological diagnosis, steroid-induced resolution of symptoms should be confirmed radiologically and followed-up.

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Section: R Esultsmentioning

confidence: 99%

Tolosa–Hunt Syndrome

Dutta

Anand

2021

Journal of Current Ophthalmology

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“…In the differential diagnosis, diseases similar to THS are diseases of various etiology, such as neoplasms, and infectious diseases 23,28,32,38 . The cases of granulomatous pachymeningitis spreading into the cavernous sinus and secondary spreading to the hypophysis were described 39 .…”

Section: Discussionmentioning

confidence: 99%

Tolosa-Hunt syndrome - diagnostic problem of painful ophthalmoplegia

Paović¹,

Paović²,

Bojkovic³

et al. 2012

VSP

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According to the International Headache Society Classification of 2004, THS is an entity that occurs rarely, its etiopathogenesis is unknown, it is manifested clinically by unilateral orbital pain associated with simple or multiple oculomotor paralyses, which resolves spontaneously but may recur. MRI orbital phlebography and biopsy are the recommended methods for making diagniosis. In our patient MRI findings and positive response to the corticosteroide treatment were relevant for making the diagnosis.

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“…As a result some advocate to routinely biopsy the supraorbital nerve in SCCs involving the forehead and brow area in order to identify the extent of tumour infiltration and to make staging more accurate. 5,16,17 Furthermore, in all patients with suspected or known skin malignancy in the periocular area, the clinician should assess for the possibility of PNI by careful examination of cranial nerves V and VII, as well as ocular motility. 11 By presenting our case, we would like to alert clinicians that a cranial neuropathy in a patient with previous history of periocular SCC, even in the absence of any positive imaging, should raise the possibility of tumour progression.…”

Section: Discussionmentioning

confidence: 99%

Perineural Spread of Cutaneous Squamous Cell Carcinoma Manifesting as Ophthalmoplegia

Koukkoulli

Koutroumanos

Kidd

2015

Neuro-Ophthalmology

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An 89-year-old female presented with horizontal diplopia and was diagnosed with VI nerve palsy attributed to a microvascular event. She subsequently progressed to develop an orbital apex syndrome, with neuroimaging demonstrating tumour invasion. Eighteen months earlier, she had squamous cell carcinoma of the forehead excised with clear margins. Intraneural and perineural spread of squamous carcinoma from the face to the cranial cavity is an important cause of delayed cranial nerve palsies after local excision of the skin tumour.

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Undiagnosed Squamous Cell Carcinoma of the Forehead Presenting as a Tolosa-Hunt Syndrome

Cited by 9 publications

References 7 publications

Tolosa–Hunt Syndrome

Tolosa–Hunt Syndrome

Tolosa-Hunt syndrome - diagnostic problem of painful ophthalmoplegia

Perineural Spread of Cutaneous Squamous Cell Carcinoma Manifesting as Ophthalmoplegia

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