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Spontaneous lateral pontine hemorrhage with associated trigeminal nerve root hematoma

Veerapen R

Neurosurgery, 1989 Sep;25(3):451-3; discussion 453-4.
PMID: 2771016

Spontaneous hemorrhage into the lateral part of the pons with sequelae compatible with survival has been documented previously. The author describes an unusual case with spontaneous hemorrhage into the lateral pons, with intraneural extension into the right trigeminal nerve root. Radiological features were of an expanding mass of the cerebellopontine angle. The patient was treated surgically with success.

Matched MeSH terms: Trigeminal Nerve/surgery*
Fulltext Ancient Schwannoma Of The Facial Nerve: An Unusual Histological Variant Of A Rare Disease

Baharudin, A., Din Suhaimi, S., Omar, E.

International Medical Journal Malaysia, 2006;5(2):1-4.
MyJurnal

Schwannomas are benign slow growing lesions arising from the Schwann cells that ensheath the axons of the peripheral, cranial and autonomic nervous systems. Intracranial schwannomas develop from the facial nerve much more rarely than from the vestibular or trigeminal nerves. Ancient schwannoma is an unusual histological variant of this rare disease. A 48 years old man who had recurrent facial nerve paralysis and right external auditory mass is presented in this case report.

Matched MeSH terms: Trigeminal Nerve
Case Report: Ocular Tilt Reaction with Internuclear Ophthalmoplegia and Multiple Cranial Nerve Palsies

Teo SK, Mohd Khialdin S, Yong MH, Othman O, Ami M

Optom Vis Sci, 2020 Dec;97(12):1018-1022.
PMID: 33252541 DOI: 10.1097/OPX.0000000000001607

SIGNIFICANCE: Ocular tilt reaction (OTR) is an abnormal eye-head postural reaction that consists of skew deviation, head tilt, and bilateral ocular torsion. Understanding of the pathway of the vestibulo-ocular reflex (VOR) is essential because this will help to localize the pathology.
PURPOSE: The aim of this study was to report a case of OTR with contralateral internuclear ophthalmoplegia (INO) and fifth and seventh cranial nerve palsies.
CASE REPORT: A 51-year-old gentleman with underlying diabetes mellitus presented with sudden onset of diplopia for 3 days. On examination, his visual acuity was 20/30 bilaterally without a relative afferent pupillary defect. He had a right OTR consisting of a right head tilt, a skew deviation with a left eye hypertropia, and bilateral ocular torsion (right excyclotorsion and left incyclotorsion) with nystagmus. He also had a left adduction deficit and right abduction nystagmus consistent with a left INO. Ocular examination revealed evidence of proliferative diabetic retinopathy bilaterally. Two days after the initial presentation, the patient developed left seventh and fifth cranial nerve palsies. MRI showed left pontine infarction and multiple chronic lacunar infarctions. There was an incidental finding of a vascular loop compression on cisternal portions of the left trigeminal, facial, and vestibulocochlear nerves. Antiplatelet treatment was started on top of a better diabetic control. The diplopia was gradually resolved with improved clinical signs. In this case, the left pontine infarction had likely affected the terminal decussated part of the vestibulocochlear nerve from the right VOR pathway, medial longitudinal fasciculus, and cranial nerve nuclei in the left pons.
CONCLUSIONS: The OTR can be ipsilateral to the lesion if the lesion is before the decussation of the VOR pathway in the pons, or it can be contralateral to the lesion if the lesion is after the decussation. In case of an OTR that is associated with contralateral INO and other contralateral cranial nerves palsy, a pathology in the pons that is contralateral to the OTR should be considered. Neuroimaging study can hence be targeted to identify the possible cause.

Matched MeSH terms: Trigeminal Nerve Diseases/diagnosis; Trigeminal Nerve Diseases/etiology*; Trigeminal Nerve Diseases/physiopathology
Improvement of trigeminal neuralgia after massage therapy and dry needling

Wan Adnan Wan Omar, Nur Liana Abu Bakar

Malaysian Journal of Medicine and Health Sciences, 2020;16(102):81-83.
MyJurnal

Trigeminal neuralgia is a debilitating disease that can lead to depression and even suicide. Trigeminal neuralgia is usually treated using carbamazepine; however, many patients are refractory to such medical treatment. Thus, other treatment modalities are required, such as physical treatment and dry needling. The objective of this case report is to describe the management of trigeminal neuralgia in a 35 years old Malay housewife, who had left side atypical trigeminal neuralgia involving V2 region in the last four years, which was refractory to medical treatment. The appli- cation of Malay massage, combined with dry needling executed along the distribution of trigeminal nerve showed an improvement of pain on the Visual Analog Scale (VAS) from 7–8/10 to 0-1/10 after 11 sessions. Therefore, Malay massage combined with dry needling can be used as a non-pharmaceutical approach to managing trigeminal neu- ralgia.

Matched MeSH terms: Trigeminal Nerve
Fulltext Classical trigeminal neuralgia, purely paroxsymal with vascular compression - a case report

B, Elamathi, R, Vijaya, V, Valliappan, A, Ramanathan

Ann Dent, 2014;21(1):33-37.
MyJurnal

According to the 3rd edition of the international
classification of headache disorders (ICHD3 2013),
Trigeminal Neuralgia (TN) is classified into two types:
1. Classical TN, purely paroxysmal 2. Classical TN
with concomitant persistent facial pain. In this article,
the authors describe a 47 year-old, male with unilateral,
severe, recurring, electric shock-like pain involving left
lower jaw, teeth and gingiva. Diagnosis of classical TN
of the left 3rd division of the trigeminal nerve was made.
The patient was treated with pharmacotherapeutic agents
but without relief. Magnetic resonance imaging (MRI)
of the brain showed medial vascular compression of left
trigeminal pontine root entry zone caused by superior
cerebellar artery. A microvascular decompression (MVD)
surgery was done at the left trigeminal pontine root entry
zone resulting in good relief of pain. This article highlights
the differential diagnoses to be considered with TN and
also emphasize the difference between the two types of
the TN according to ICDH3 (2013). It also highlights the
difference between classical TN purely paroxysmal with
and without vascular compression by imaging techniques
and their differing treatment modalities, which therefore
should be reflected in future ICDH classification.

Matched MeSH terms: Trigeminal Nerve
Intranasal Drug Delivery: A Non-Invasive Approach for the Better Delivery of Neurotherapeutics

Kumar H, Mishra G, Sharma AK, Gothwal A, Kesharwani P, Gupta U

Pharm Nanotechnol, 2017;5(3):203-214.
PMID: 28521670 DOI: 10.2174/2211738505666170515113936

BACKGROUND: The convoluted pathophysiology of brain disorders along with penetration issue of drugs to brain represents major hurdle that requires some novel therapies. The blood-brain barrier (BBB) denotes a rigid barrier for delivery of therapeutics in vivo; to overcome this barrier, intranasal delivery is an excellent strategy to deliver the drug directly to brain via olfactory and trigeminal nerve pathways that originate as olfactory neuro-epithelium in the nasal cavity and terminate in brain.
METHOD: Kind of therapeutics like low molecular weight drugs can be delivered to the CNS via this route. In this review, we have outlined the anatomy and physiological aspect of nasal mucosa, certain hurdles, various strategies including importance of muco-adhesive polymers to increase the drug delivery and possible clinical prospects that partly contribute in intranasal drug delivery.
RESULTS: Exhaustive literature survey related to intranasal drug delivery system revealed the new strategy that circumvents the BBB, based on non-invasive concept for treating various CNS disorders. Numerous advantages like prompt effects, self-medication through wide-ranging devices, and the frequent as well protracted dosing are associated with this novel route.
CONCLUSION: Recently few reports have proven that nasal to brain drug delivery system bypasses the BBB. This novel route is associated with targeting efficiency and less exposure of therapeutic substances to non-target site. Nevertheless, this route desires much more research into the safe transferring of therapeutics to the brain. Role of muco-adhesive polymer and surface modification with specific ligands are area of interest of researcher to explore more about this.

Matched MeSH terms: Trigeminal Nerve/metabolism
Herpes Zoster Ophthalmicus with Orbital Apex Syndrome-Difference in Outcomes and Literature Review

Lim JJ, Ong YM, Wan Zalina MZ, Choo MM

Ocul Immunol Inflamm, 2018;26(2):187-193.
PMID: 28622058 DOI: 10.1080/09273948.2017.1327604
Matched MeSH terms: Trigeminal Nerve Diseases/diagnosis; Trigeminal Nerve Diseases/drug therapy; Trigeminal Nerve Diseases/virology
Fulltext Recurrent optic neuritis as early presentation of idiopathic hypertrophic cranial pachymeningitis

Norhayaty Samsudin, Tai, Evelyn Li Min, Chui, Yain Chen, Kumar, Lakana, Azhany Yaakub, Adil Hussein, et al.

Journal of Biomedical and Clinical Sciences, 2017;2(1):23-26.
MyJurnal

44-year-old Malay lady presented with drooping of the right eyelid and worsening of left eye vision for one week duration. There was associated headache, periorbital discomfort and diplopia on left gaze. She previously had a history of recurrent optic neuritis affecting both eyes over a period of 12 years. On examination, there was right-sided partial ptosis and left exotropia. The adduction, abduction, elevation and depression of the right eye was limited. Left eye extraocular movements were full. The right eye visual acuity was 6/9, while the left eye visual acuity was perception to light, with a positive relative afferent papillary defect and a pale optic disc. The right optic disc was normal. There was reduced sensation in the trigeminal nerve distribution over the right side of the face. Neurological examination was otherwise normal. Magnetic resonance imaging of the brain and orbit revealed meningeal thickening with involvement of the right orbital apex and cavernous sinus. Blood investigations for infectious and autoimmune causes were unremarkable. She was diagnosed to have idiopathic hypertrophic cranial pachymeningitis and treated with systemic corticosteroids. The right eye extraocular motility improved, while the left eye visual acuity improved to counting finger. This case demonstrates that idiopathic hypertrophic cranial pachymeningitis may present as recurrent optic neuritis in the early phase, before radiological evidence of the disease is present. A high index of suspicion for the underlying cause is essential to prevent irreversible optic nerve damage due to recurrent optic neuritis.

Matched MeSH terms: Trigeminal Nerve
Fulltext Age-Dependent Anti-migraine Effects of Valproic Acid and Topiramate in Rats

Huang P, Kuo PH, Lee MT, Chiou LC, Fan PC

Front Pharmacol, 2018;9:1095.
PMID: 30319425 DOI: 10.3389/fphar.2018.01095

Background: Valproic acid (VPA) and topiramate (TPM), initially developed as antiepileptics, are approved for migraine prophylaxis in adults but not children. The differences in their antimigraine mechanism(s) by age remain unclear. Methods: A migraine model induced by intra-cisternal (i.c.) capsaicin instillation in pediatric (4-5 weeks) and adult (8-9 weeks) rats was pretreated with VPA (30, 100 mg/kg) or TPM (10, 30, 100 mg/kg). Noxious meningeal stimulation by the irritant capsaicin triggered trigeminovascular system (TGVS) activation mimicking migraine condition, which were assessed peripherally by the depletion of calcitonin gene-related peptide (CGRP) in sensory nerve fibers of the dura mater, the increased CGRP immunoreactivity at trigeminal ganglia (TG) and centrally by the number of c-Fos-immunoreactive (c-Fos-ir) neurons in the trigeminocervical complex (TCC). Peripherally, CGRP released from dural sensory nerve terminals of TG triggered pain signal transmission in the primary afferent of trigeminal nerve, which in turn caused central sensitization of the TGVS due to TCC activation and hence contributed to migraine. Results: In the VPA-treated group, the central responsiveness expressed by reducing the number of c-Fos-ir neurons, which had been increased by i.c. capsaicin, was significant in pediatric, but not adult, rats. Inversely, VPA was effective in peripheral inhibition of elevated CGRP immunoreactivity in the TG and CGRP depletion in the dura mater of adult, but not pediatric, rats. In TPM group, the central responsiveness was significant in both adult and pediatric groups. Peripherally, TPM significantly inhibited capsaicin-induced CGRP expression of TG in adult, but not pediatric, rats. Interestingly, the capsaicin-induced depletion of CGRP in dura was significantly rescued by TPM at high doses in adults, but at low dose in pediatric group. Conclusion: These results suggest VPA exerted peripheral inhibition in adult, but central suppression in pediatric migraine-rats. In contrast, TPM involves both central and peripheral inhibition of migraine with an optimal therapeutic window in both ages. These findings may clarify the age-dependent anti-migraine mechanism of VPA and TPM, which may guide the development of new pediatric anti-migraine drugs in the future.

Matched MeSH terms: Trigeminal Nerve
Retromolar foramen and canal: a comprehensive review on its anatomy and clinical applications

Kumar Potu B, Jagadeesan S, Bhat KM, Rao Sirasanagandla S

Morphologie, 2013 Jun;97(317):31-7.
PMID: 23806306 DOI: 10.1016/j.morpho.2013.04.004

The retromolar foramen (RMF) and retromolar canal (RMC) are the anatomical structures of the mandible located in retromolar fossa behind the third molar tooth. This foramen and canal contain neurovascular structures which provide accessory/additional innervation to the mandibular molars and the buccal area. These neurovascular contents of the canal gain more importance in medical and dental practice, because these elements are vulnerable to damage during placement of osteointegrated implants, endodontic treatment and sagittal split osteotomy surgeries and a detailed knowledge of this anatomical variation would be vital in understanding failed inferior alveolar nerve blockage, spread of infection and also metastasis. Although few studies have been conducted in the past showing the incidence and types in different population groups, a lacunae in comprehensive review of this structure is lacking. Though this variation posed challenging situations for the practicing surgeons, it has been quite neglected and the incidence of it is not well presented in all the textbooks. Hence, we made an attempt to provide a consolidated review regarding variations and clinical applications of the RMF and RMC.

Matched MeSH terms: Trigeminal Nerve Injuries/prevention & control