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Year : 2010  |  Volume : 2  |  Issue : 1  |  Page : 65-66
Trigeminal neuralgia in an HIV patient


1 EKO CT & MRI Scan Centre, Medical College and Hospitals Campus, Kolkata, India
2 Department of Neurology, Medical College and Hospitals, Kolkata, India
3 School of Tropical Medicines, Kolkata, India

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Date of Web Publication20-Jan-2010
 

   Abstract 

Trigeminal neuralgia is a painful condition affecting face. Its commonest cause is the tortuous vessels in prepontine cistern. There are other causes also, like brainstem lesions and mass lesions, as well as inflammatory causes. We present a case of an HIV patient with marked involvement of trigeminal nerves, which is a unique finding in immunocompromised patients.

Keywords: Human immunodeficiency virus, Trigeminal nerve, Magnetic resonance imaging (MRI)

How to cite this article:
Hashmi MA, Guha G, Saha B. Trigeminal neuralgia in an HIV patient. J Global Infect Dis 2010;2:65-6

How to cite this URL:
Hashmi MA, Guha G, Saha B. Trigeminal neuralgia in an HIV patient. J Global Infect Dis [serial online] 2010 [cited 2020 Dec 4];2:65-6. Available from: https://www.jgid.org/text.asp?2010/2/1/65/59254



   Introduction Top


Trigeminal nerve is the largest of all the cranial nerves. It transmits sensory information from the face, oral and nasal cavities and most of the scalp and caries motor supply to the muscles of mastication. Disease involving nerve or adjacent to it can cause trigeminal neuralgia or loss of sensory or motor function in the distribution of the nerve. Disease affecting it can cause intense pain along its distribution. Neuropathy can affect the nerve from its origin in brainstem to its peripheral branches. [1] The nerve can be divided into four segments: brainstem, cisternal, Meckel's cave and cavernous sinus and extracranial course. [2] The commonest cause is vascular compression by tortuous vessel. [3] An inflammatory cause like meningitis can cause trigeminal neuralgia.


   Case Report Top


An immunocompromised patient presented to us from the School of Tropical Medicine with pain around face, lips, eyes, scalp and forehead. The study was done on 1.5 tesla General Electronics signa. Contrast Gadodiamide (Omniscan) was used. Routine brain MRI was done. Plain MRI showed marked thickened trigeminal nerve bilaterally [Figure 1]. Post-contrast study showed marked enhancement of the above nerves [Figure 2].


   Discussion Top


Trigeminal neuropathy can involve the whole nerve or part of the nerve from its origin to its peripheral branches. [1] Brainstem lesions affect mainly the nuclei of trigeminal nerves. Cerebrovascular causes are the commonest. The patient can have other symptoms. Demyelinating lesions like multiple sclerosis may affect brainstem. [2],[4],[5] Other white matter signals can also be seen in brain imaging. Mass lesions, mainly gliomas, involve brainstem. [2] Vascular malformation [6] and hamartomas are other conditions that affect brainstem. Viral rhombencephalitis can also affect brainstem. [7]

Tortuous vessel in prepontine cistern is considered to be the commonest cause of trigeminal neuralgia. Branches from superior cerebellar artery may cause pressure effect on the nerve. [3] Cerebellopontine-angle neoplasm's may cause neuropathy by compression on the nerve. Acoustic neuromas, meningiomas, [8] arachnoid cysts, epidermoid cysts [9] and metastatic lesions are found in this location. [2]

Meckel's cave or cavernous sinus lesions are meningioma, epidermoid tumor [10] and trigeminal neuroma. [1],[2] Granulomatous or inflammatory diseases, such as neurosarcoid or tuberculosis, may involve the nerve or ganglion at this site. Vascular lesions like aneurysm can also cause pressure effect. Extracranial lesions can be mass lesion or any inflammatory condition.

Marked involvement of the trigeminal nerves in the above condition appears to be inflammatory and a combination of cisternal and Meckel's cave lesions. Sequelae of basal meningitis can affect cranial nerves.

 
   References Top

1.Majoie CB, Verbeeten B Jr, Dol JA, Peeters FL. Trigeminal neuropathy, evaluation with MR imaging. RadioGraphics 1995;15:795-811.   Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Woolfall P, Coulthard A. Trigeminal nerve: anatomy and pathology.Br J Radiol 2001;74:458-67.  Back to cited text no. 2      
3.Sens MA, Higer HP. MRI of trigeminal neuralgia; Initial clinical results in patients with vascular compression of the trigeminal nerve. Neurosurg Rev 1991;14:69-71.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Tien RD, Dillon WP. Herpes trigeminal neuritis and rhombencephalitis on Gd-DTPA-enhanced MR imaging. AJNR Am J Neuroradiol 1990;11:413-4.   Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Hutchins LG, Harnsberger HR, Jacobs JM, Apfelbaum RI. Trigeminal neuralgia (tic douloureux): MR imaging assessment. Radiology ;1990; 175:837-41.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Gomori JM, Grossman RI, Goldberg HI, Hackney DB, Zimmerman RA, Bilaniuk LT. Occult cerebral vascular malformations-High-field MR imaging. Radiology 1986;158:707-13.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Yang J, Simonson TM, Ruprecht A, Meng D, Vincent SD, Yuh WT. Magnetic resonance imaging used to assess patients with trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:343-50.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Bilaniuk LT, Molloy PT, Zimmerman RA, Phillips PC, Vaughan SN, Liu GT, et al. Neurofibromatosis type 1: brain stem tumours. Neuroradiology 1997;39:642-53.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Goru SJ, Pemberton MN. Trigeminal neuralgia: The role of magnetic resonance imaging. Br J Oral Maxillofac Surg 2009;47:228-9.   Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Tampieri D, Melanson D, Ethier R. MR imaging of epidermoid cysts. Am J Neuroradiol 1989;10:351-6.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Mohammad A Hashmi
EKO CT & MRI Scan Centre, Medical College and Hospitals Campus, Kolkata
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.59254

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    Abstract
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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