[Chronic facial pain due to a brainstem cavernoma].
Idiopathic trigeminal neuralgia is almost always associated with pathological nerve/vessel contact. Symptomatic forms of trigeminal neuralgia include cases of multiple sclerosis, infratentorial tumours and postherpetic neuralgia. Vascular malformations causing neuralgia have rarely been reported. We present the case of a 55-year old woman, who suffered from facial pain and ptosis on her left side. Repeated neurological examinations as well as repeated magnetic resonance imaging did not lead to a definite diagnosis or therapy. The pain suddenly stopped three weeks before admission and only a slight left sided facial hypaesthesia persisted. Reevaluating the older MRI we found a small signal alteration of 2 mm in the caudal part of the left trigeminal nucleus. A new MRI showed a subacute haemorrhage into a small brainstem cavernoma, which must have caused the pain and later on the hypaesthesia. Small vascular malformations are a rare cause of neuropathic facial pain.
Stellmann
J-P
JP
Asklepios Klinik Harburg-Neurologie, Eissendorfer Pferdeweg 52, 21075 Hamburg. jpstellmann@jamboss.de
Kuhn
M
M
Töpper
R
R
D001933:Brain Stem / Q000002:abnormalities / Q000098:blood supply*; D002543:Cerebral Hemorrhage / Q000150:complications; D002560:Cerebrovascular Circulation / Q000502:physiology; D002908:Chronic Disease; D005157:Facial Pain / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology