Secondary Trigeminal Neuralgia: Do Not Forget the Pontine Ischemic Infarction

Cabral, Gonçalo; Lorga, Tiago; Caetano, André; Baptista, Tiago; Viana-Baptista, Miguel

doi:10.1159/000517361

Cited by 4 publications

(1 citation statement)

References 2 publications

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“…8 There are some more isolated case reports of TN developing after ischemic pontine lesions. [9][10][11][12][13][14] Others have pointed to an association of pontine lesions with TN but have not associated them with brain infarction. Arrese et al 15 reviewed 68 cases of non-MS-TN and found that four of them showed hyperintense lesions in the dorsolateral pons on T2weighted MRI sequences.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency thermocoagulation for the treatment of trigeminal neuralgia associated with a focal pontine lesion: illustrative case

Biloshytsky,

Skorokhoda,

Buvailo

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Trigeminal neuralgia (TN) associated with a focal pontine lesion is a rare but challenging condition. The origin of the lesion, which does not fulfill the diagnostic criteria for multiple sclerosis, remains disputable. Pain in such conditions is often refractory to treatment, including microvascular decompression. OBSERVATIONS A 36-year-old female presented with a 3.5-year history of shooting pain in the right V2 distribution triggered by talking and chewing. She became less responsive to high-dose carbamazepine over time. Magnetic resonance imaging (MRI) revealed no neurovascular compression but an elongated lesion hyperintense on T2-weighted imaging and T2- fluid-attenuated inversion recovery and hypointense and nonenhancing on T1-magnetization prepared rapid gradient-echo imaging without restricted diffusion, hemorrhage, or supposed malformation along the right pontine trigeminal pathway (PTP). Two other similar lesions were found in the corpus callosum and left thalamus. All lesions were stable compared to MRI data obtained 2 years before. Cerebrospinal fluid contained no oligoclonal bands. Pain attacks ceased with right-sided gasserian radiofrequency thermocoagulation (RFTC), and at the 6-month follow-up, there was no recurrence. LESSONS In patients with TN, preoperative neuroimaging should assess for brainstem lesions along the PTP. RFTC can be considered a treatment option in medication-refractory TN associated with a focal pontine lesion.

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