Of all the Nerve

Dysphagia; Dysarthria; Left facial numbnessA 46-year old male with difficulty swallowing and right facial droop. Previous history significant for cancer, bipolar disease, pseudopseudohypoparathyroidism and a personal history of polysubstance abuse along with a 34-year history of heavy smoking.VA: 20/50 OD, 20/200 OS; Color plates: 14/15 OD, 0/15 OSCT; MRIMalignant epithelial cells with fibrosis and inflammation of the peripheral nerves.Surgery; Antineoplastic agents1. Krendel DA, Ditter SM, Frankel MR, Ross WK, Biopsy proven cerebral vasculitis associated with cocaine abuse. Neurology, 40, 1092, 1990. 2. Ballantyne AJ, McCarten AB, Ibanez IL, The extension of cancer of the head and neck through peripheral nerves, AmerJ Surg, 106, 651, 1963. 3. Clouston PD, Sharpe DM, Corbett AJ, Kos S, Kennedy PJ, Perineural spread of cutaneous head and neck cancer - its orbital and central neurologic complications, Arch Neurol, 47, 73, 1 990. 4. ten Hove MW, Glaser JS, Schatz JS, Occult perineural tumor infiltration of the trigeminal nerve, J Neuro-Ophthalmol, 17(3), 170, 1997. 5. Trobe JD, Hood CI, Parsons JT, Quisling RG, Intracranial extension of squamous carcinoma along trigeminal nerve, Arch Ophthalmol, 100(4), 608, 1982. 6. Sullivan LM, Smee R, Leptomeningeal carcinomatosis from perineural invasion of lip squamous cell carcinoma, Australasian Radiology, 50, 262, 2006. 7. Nogajski JH, Brewer J, Storey CE, Perineural spread of facial squamous cell carcinoma, J Clin Neurosci, 13, 400, 2006