Gangrene of Face Following Occlusion of Posterior Inferior Cerebellar Artery

Abstract

CHANGES in the skin as a result of disease of the trigeminal nerve have rarely been reported. Most such lesions followed surgical section of this nerve or injections in its peripheral pathway for the relief of tic douloureux. Karnosh and Scherb 1 reported an eczematous eruption in the distribution of the first and second divisions following section of these branches. Harris 2 stated that superficial ulcerations at the ala nasi, and more rarely on the cheek and forehead, follow injections of alcohol into the gasserian ganglion in a small percentage of cases. Schornstein 3 reported 8 cases of progressive ulceration, commencing at the ala nasi, subsequent to retroganglionic section and injection of alcohol into the ganglion. Necrosis of the maxillary mucous membrane occurring twelve years after a retrogasserian neurectomy was recorded by Dechaume and Delib\l=e'\ros.4 They stated that an ill fitting denture was the probable precipitating cause. Three cases of postoperative erosion of the nasal region were observed by Peet5 in 1,000 resections of the sensory root. Mixter 6 stated that after section of the posterior root paraesthesias may be so distressing that "one will often find a patient with a bit of the skin . . . scratched off." Becker 7 reported an erythemato-

Common Neuropathic Itch Syndromes

“…The most common brain lesion causing neuropathic itch is cerebral infarction, particularly strokes that affect the lateral medulla to cause Wallenberg's syndrome or slightly higher stokes in the lateral pons where itch signals likely ascend (25)(26)(27)(28). Central lesions, most often vertebrobasilar stroke, are said to cause about 1/5 of cases of TTS (29).…”

Neuropathic Itch

“…38,39 The complete syndrome is caused by infarction of a wedge of lateral medulla, in most cases from vertebral-artery blockage. Occasional cases are attributed to smaller strokes in this same territory, for instance involving the posterior inferior cerebellar artery (PICA), 40,41 or thalamus. 33 The full picture includes signs of abnormality of the vestibular system (vertigo, nystagmus, oscillopsia, vomiting), spinothalamic tract (ipsilateral loss of body pain and temperature), descending sympathetic tract (ipsilateral Horner syndrome) and cranial nerves IX and X (hoarseness and choking), otolithic nucleus (double vision), cerebellar connections (ipsilateral ataxia), as well as the descending tract and nucleus of the trigeminal (V) nerve causing loss of pain and temperature on the ipsilateral face.…”

The Syndromes of the Arteries of the Brain and Spinal Cord

“…The opposite side of the face is rarely affected because the quintothalamic tract which arises from the spinal nucleus of the fifth nerve pursues a separate path in the medulla oblongata close to the medial lemniscus and does not join the spinothalamic tract until it reaches the pons (Smyth, 1939). Trophic changes, including gangrene of the side of the nose and adjoining cheek have been reported, usually associated with the use of a nasal catheter (Savitsky and Elpern, 1948).…”