Tics and Fleas (PowerPoint)

Tic douloureux; Horizontal binocular diplopiaA 61-year old female with tic douloureux and diplopia. Previous history significant for squamous cell skin cancer below right eye, surgically resected. Dx atypical trigeminal neuralgia after neurological consult following administration of local anesthetic for basal cell carcinoma resection.Complete right abduction deficit; Decreased sensation in right V1, V2, V3MRI; MRANeurtrophic spread of squamous cell carcinoma; Small non-caseating granulomas with scatters of enlarged atypical cells with enlarged nuclei characteristic of Reed-Sternberg cells.Surgery; Antineoplastic antibiotics; XRT1. Leach BC, Kulbersh JS, Day TA, Cook J. Cranial neuropathy as a presenting sign of recurrent aggressive skin cancer. Dermatol Surg. 2008 Apr;34(4):483-97. 2. Liebig C, Ayala G, Wilks JA, Berger DH, Albo D. Perineural invasion in cancer: a review of the literature. Cancer. 2009 Aug 1;115(15):3379-91. 3. Maroldi R, Farina D, Borghesi A, Marconi A, Gatti E. Perineural tumor spread. 4. Neuroimaging Clin N Am. 2008 May;18(2):413-29, xi. 5. Ibrahim M, Parmar H, Gandhi D, Mukherji SK. Imaging nuances of perineural spread of head and neck malignancies. J Neuroophthalmol. 2007 Jun;27(2):129-37. 6. Parker GD, Harnsberger HR. Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics. 1991 May;11(3):383-99