title: Epidermoid cyst presenting as isolated trigeminal neuralgia - two case reports.
abstract: OBJECTIVE
  Symptomatic TN accounts for up to 15% of all TN. Though there are many established "red flag" signs, it is still sometimes difficult to sift symptomatic from classic TN. We herein report two cases of isolated TN with normal neurologic examinations and then tissue proved as epidermoid cyst.
  
  
  METHODS
  
  
  
  METHODS
  A 17-year-old girl presented with paroxysmal intense pain mixed dull background pain at right mandibular region for one month. The blink reflex demonstrated brainstem lesion and brain magnetic resonance imaging (MRI) revealed a huge lobulated tumor in right cerebellopontine angle (CPA) with obvious brainstem compression. Her right facial pain was nearly completely disappeared postoperatively.
  
  
  METHODS
  The 48-year-old woman had chronic paroxysmal electric-like and burning pain in left V3 region for more than 5 years. Because of refractory pain, brain MRI was arranged and showed a non-enhancing cystic lesion at left CPA. Post operative complications occurred as left multiple lower cranial nerve palsies and Horner syndrome, and truncal ataxia. Her facial pain was completely free after 1 month follow up.
  
  
  CONCLUSIONS
  In the first patient, teenage onset, abnormal trigeminal reflex, and early developing background pain struck us directly to symptomatic TN. In the second case, we suspected symptomatic TN with uncertainty before image study. TN could be the isolated initial symptom of CPA epidermoid cysts. In consideration about pretty high prevalence of symptomatic TN, physicians should be more alert and straightforward arrange neuroimage when facing TN patients with atypical presentation.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan.
authors.forename: Ling-Chien
authors.initials: LC
authors.lastname: Hung
authors.forename: Chi-Shun
authors.initials: CS
authors.lastname: Wu
authors.forename: Chou-Ching
authors.initials: CC
authors.lastname: Lin
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Fang
authors.forename: Yung-Chu
authors.initials: YC
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D001767:Blinking / Q000502:physiology; D002530:Cerebellopontine Angle / Q000473:pathology; D004814:Epidermal Cyst / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014277:Trigeminal Neuralgia / Q000503:physiopathology*