title: [A case of acute autonomic, sensory and motor neuropathy with swelling and gadolinium enhancement of bilateral trigeminal nerve on MRI and dissociation between superficial and deep sensation disturbance].
abstract: We report a case of a 46-year old man with acute autonomic, sensory and motor neuropathy (AASMN). He developed severe orthostatic hypotension, anuria,anhydrosis, tonic pupil with dysarthria, dysphagia, jaw claudication, and dysesthesia and sharp pain several days after symptom of upper respiratory infection. Neurological examination revealed severely decreased superficial sensation with normal deep sensation. Brain MRI findings showed bilateral trigeminal nerve swelling with gadolinium (Gd) enhancement. His motor and sensory symptoms and MRI abnormality were improved after the administration of intravenous immunoglobulin and intravenous methylprednisolone therapy; however his autonomic symptoms scarcely reacted to these immunotherapies. As long as we investigated in AASMN cases, bilateral trigeminal nerve swelling with Gd enhancement and dissociation between superficial and deep sensation disturbance have not reported, suggesting that the present case mainly disrupted C nerve fibers distributing postganglionic autonomic and temperature-pain sensory nerves.
authors.affiliation: Department of Neurology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Naito
authors.forename: Hikaru
authors.initials: H
authors.lastname: Doi
authors.forename: Saeko
authors.initials: S
authors.lastname: Inamizu
authors.forename: Hijiri
authors.initials: H
authors.lastname: Ito
authors.forename: Takehisa
authors.initials: T
authors.lastname: Araki
mesh_terms: D000208:Acute Disease; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012678:Sensation Disorders / Q000175:diagnosis; D014276:Trigeminal Nerve / Q000473:pathology*
chemical_list: D005682:Gadolinium