Siritho Sasitorn, Pumpradit Wadchara, Suriyajakryuththana Wiboon, Pongpirul Krit
Bumrungrad International Hospital, Bangkok 10110, Thailand.
Bumrungrad International Hospital, Bangkok 10110, Thailand ; Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand ; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Case Rep Radiol. 2015;2015:402015. doi: 10.1155/2015/402015. Epub 2015 Apr 2.
A 43-year-old female presented with severe sharp stabbing right-sided periorbital and retroorbital area headache, dull-aching unilateral jaw pain, eyelid swelling, ptosis, and tearing of the right eye but no rash. The pain episodes lasted five minutes to one hour and occurred 10-15 times per day with unremitting milder pain between the attacks. She later developed an erythematous maculopapular rash over the right forehead and therefore was treated with antivirals. MRI performed one month after the onset revealed small hypersignal-T2 in the right dorsolateral mid-pons and from the right dorsolateral aspect of the pontomedullary region to the right dorsolateral aspect of the upper cervical cord, along the course of the principal sensory nucleus and spinal nucleus of the right trigeminal nerve. No definite contrast enhancement of the right brain stem/upper cervical cord was seen. Orbital imaging showed no abnormality of bilateral optic nerves/chiasm, extraocular muscles, and globes. Slight enhancement of the right V1, V2, and the cisterna right trigeminal nerve was detected. Our findings support the hypothesis of direct involvement by virus theory, reflecting rostral viral transmission along the gasserian ganglion to the trigeminal nuclei at brainstem and caudal spreading along the descending tract of CN V.
一名43岁女性出现右侧眶周和眶后区域严重的尖锐刺痛性头痛、单侧下颌钝痛、眼睑肿胀、上睑下垂和右眼流泪，但无皮疹。疼痛发作持续5分钟至1小时，每天发作10 - 15次，发作期间有持续的较轻疼痛。她后来右侧前额出现红斑性斑丘疹皮疹，因此接受了抗病毒治疗。发病1个月后进行的MRI显示，在右侧脑桥背外侧中部以及从脑桥延髓区域的右侧背外侧至颈髓上段右侧背外侧，沿右侧三叉神经的主要感觉核和脊髓核走行有小的T2高信号。右侧脑干/颈髓上段未见明确的强化。眼眶成像显示双侧视神经/视交叉、眼外肌和眼球无异常。检测到右侧V1、V2和右侧三叉神经池有轻微强化。我们的研究结果支持病毒直接累及理论的假说，反映了病毒沿半月神经节向脑干三叉神经核的向头端传播以及沿三叉神经下行束向尾端扩散。
