Trigeminal neuralgia as an unusual isolated symptom of pituitary adenoma: case report and review of the literature

Abstract

ABSTRACTneurological deficit and not attributable to another headache cause (3,12). Episodes of pain start unexpectedly and should last seconds to minutes. The non-painful stimulation of trigger points that located ipsilateral side of pain could initiated pain episodes. after the pain attacks, there is often a refractive period (14). The most common etiology for TN is disturbance of TN at the root entry zone by a vessel, generally the superior cerebellar artery. However, TN may be present in the absence of vascular contact (15).The cavernous sinus (CS) is a form of large venous space containing the oculomotor nerve, trochlear nerve, ophthalmic and maxillary divisions of trigeminal nerve (located in the lateral wall) and also has internal carotid artery and abducent nerve (located in the central portion) (10). █ InTRODuCTIOnPituitary adenomas (PAs), which are benign tumors of the adenohypophysis, account for approximately 10% of intracranial tumors and 5% of adenomas, are locally invasive. PAs can be classified as hormone active adenomas and hormone inactive adenomas that can reach huge proportions without any sign or symptom (10).Trigeminal Neuralgia (TN) is one of the most frequent cranial neuralgias. The incidence of TN is approximately 4 per 100 000 persons per year (9). TNs are paroxysmal attacks of pain lasting from a second to 2 minutes and affecting one or more divisions of the trigeminal nerve (3, 12). The pain of TN must have at least one of the following characteristics: as intense, sharp, stabbing, activated by trigger factors, without evident Pituitary adenomas account for approximately 10% of intracranial tumors and 5% are locally invasive. Cavernous sinus invasion by pituitary tumors presents mostly with cranial nerve palsies, especially involving the third, fourth and sixth cranial nerves, which is well documented in the literature. However, an isolated complaint of trigeminal neuralgia due to pituitary adenoma is an extremely rare entity with a limited number of reported cases. A 51-year-old female patient presented to our clinic with complaints of pain and numbness on the left side of face for six months, with each event lasting 5-10 seconds. No improvement was obtained with administration of carbamazepine therapy. Magnetic resonance imaging of the sellar region revealed a mass with the left cavernous sinus invasion. The patient underwent surgery via endoscopic transsphenoidal approach and after than radiosurgery with gammaknife. The patient's complaints resolved totally after gamma-knife radiosurgery. We report herein a case of pituitary adenoma with an isolated complaint of trigeminal neuralgia. Pituitary adenomas may be presented with cavernous sinus invasion and multiple cranial nerve palsies but isolated trigeminal neuralgia due to pituitary adenoma is an extremely rare entity.

Tanshinone IIA induces apoptosis via inhibition of Wnt/β-catenin/MGMT signaling in AtT-20 cells

“…Pituitary adenomas account for ~10% of intracranial tumors, and 5% are locally invasive ( 1 ). Although the etiology of pituitary adenoma is not fully understood, numerous experimental and clinical observations indicate that DNA repair enzyme O 6 -methylguanine-DNA methyltransferase (MGMT) is implicated in the pathogenesis of various tumor types, including pituitary adenoma ( 2 , 3 ).…”

Trigeminal Neuralgia Secondary to Intracranial Neoplastic Lesions: a Case Series and Comprehensive Review

“…4 So a careful examination of all the cranial nerves along with MRI of the brain is advisable in patients younger than 60 years. 4,7,8 To identify the presence of structural lesions like a tumor, cerebral aneurysm, acoustic neuroma, and so forth, this age limit was probably placed to recognize radiologically and clinically the patients who could benefit better from the prognostic point of view of diagnosis and surgical treatment in terms of mortality and morbidity. The mechanisms through which tumors induce neuralgia are multiple and include direct injury or interference with trigeminal pain transmission pathways or nuclei, direct compression of the nerve, or provocation of a neurovascular conflict in the cisternal tract of the nerve.…”