da Silva C J, da Rocha A J, Mendes M F, Maia A C M, Braga F T, Tilbery C P
Centro de Medicina Diagnóstica, Setor de Imagem, Laboratório Fleury, São Paulo-SP, Brazil.
Mult Scler. 2005 Jun;11(3):282-5. doi: 10.1191/1352458505ms1186oa.
Trigeminal involvement detected by magnetic resonance imaging (MRI) in multiple sclerosis (MS) patients is usually associated with trigeminal neuralgia (TN) or painless paraesthesia in the trigeminal distribution. Our aim is to review the incidence of trigeminal involvement on MRI in a series of patients with MS at our institution, with further clinical correlation. We reviewed MRI scans of 275 MS patients for the presence of gadolinium enhancement on postcontrast T1-weighted images, anatomical and signal abnormalities on different sequences at the pontine trigeminal root entry zone (REZ) and in the cisternal portion of the nerves. We observed enhancement in the cisternal portion of the nerves and signal abnormalities (with or without enhancement) at the pontine trigeminal REZ in 8 (2.9%) patients, and enhancement was bilateral in 6 (75%) of those. Despite the inflammatory activity, none of them had TN and 3 (37.5%) had only painless paraesthesias in the correspondent V3 distribution. We also found a marked trigeminal hypertrophy in 2 (25%) patients, both with a longer period of disease. Our results confirm a high and clinically silent incidence of trigeminal involvement in MS patients, and suggest a simultaneous role of the central and peripheral type of myelin in trigeminal demyelination.
通过磁共振成像（MRI）检测到的多发性硬化症（MS）患者的三叉神经受累通常与三叉神经痛（TN）或三叉神经分布区域的无痛性感觉异常有关。我们的目的是回顾在我们机构的一系列MS患者中MRI上三叉神经受累的发生率，并进行进一步的临床相关性分析。我们回顾了275例MS患者的MRI扫描，观察钆增强在对比剂后T1加权图像上的表现，以及脑桥三叉神经根入区（REZ）和神经脑池段在不同序列上的解剖和信号异常情况。我们观察到8例（2.9%）患者的神经脑池段有增强，脑桥三叉神经REZ有信号异常（伴或不伴增强），其中6例（75%）为双侧增强。尽管有炎症活动，但他们均无三叉神经痛，3例（37.5%）仅在相应的V3分布区域有无痛性感觉异常。我们还发现2例（25%）患者有明显的三叉神经肥大，这2例患者病程均较长。我们的结果证实了MS患者三叉神经受累的发生率较高且无临床症状，并提示中枢型和周围型髓鞘在三叉神经脱髓鞘中可能同时起作用。
