Nelson Daniel G, Bidot Samuel S, Esper Gregory J, Newman Nancy J, Biousse Valérie
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
Taiwan J Ophthalmol. 2020 Nov 19;11(1):86-88. doi: 10.4103/tjo.tjo_62_20. eCollection 2021 Jan-Mar.
Perineural spread (PNS) to cranial nerves (CNs) by cutaneous malignancies is difficult to diagnose given the indolent course and often late or absent findings on brain imaging. A 68-year-old white man with multiple cranial neuropathies secondary to PNS by squamous cell carcinoma had negative high-quality neuroimaging for 5.25 years. He first developed left facial numbness, followed 39 months later by a left CN VI palsy. Subsequent examinations over 2 years showed involvement of left seventh, right trigeminal V1-V3, and right sixth, and bilateral third nerve palsies. Repeat high-quality brain magnetic resonance imaging (MRIs) during this time showed no identifiable CNs abnormality. Full body positron emission tomography imaging and cerebrospinal fluid studies were normal. 5.25 years after initial sensory symptom onset, MRI showed new enhancement along the right mandibular branch of the trigeminal nerve with foramen ovale widening. Autopsy showed squamous cell carcinoma within both CNs sixth. A long interval to diagnosis of PNS is associated with high morbidity, emphasizing the need for earlier methods of detection when clinical suspicion is high.
皮肤恶性肿瘤向颅神经的神经周围扩散（PNS）很难诊断，因为其病程进展缓慢，且脑部影像学检查结果往往较晚出现或无异常表现。一名68岁白人男性因鳞状细胞癌导致的PNS继发多发性颅神经病变，高质量神经影像学检查在5.25年内均为阴性。他最初出现左侧面部麻木，39个月后出现左侧第六颅神经麻痹。随后2年的检查显示左侧第七、右侧三叉神经V1 - V3、右侧第六以及双侧第三神经麻痹。在此期间重复进行的高质量脑部磁共振成像（MRI）未发现可识别的颅神经异常。全身正电子发射断层扫描成像和脑脊液检查均正常。初始感觉症状出现5.25年后，MRI显示三叉神经右下颌支沿线有新的强化，卵圆孔增宽。尸检显示双侧第六颅神经内有鳞状细胞癌。PNS诊断的长时间间隔与高发病率相关，强调当临床怀疑度高时需要更早的检测方法。
