J Oral Facial Pain Headache. 2017;31(4):e4-e6. doi: 10.11607/ofph.1831.
Although several reports have indicated that trigeminal neuralgia related to multiple sclerosis may occur bilaterally in the orofacial region, trigeminal neuralgia pain usually involves the two sides in different time lapses, and the simultaneous involvement of trigeminal territories on both sides is commonly considered incompatible with its diagnosis. This case report describes a patient with bilateral trigeminal neuralgia related to multiple sclerosis that started simultaneously on both sides of the orofacial region. A 55-year-old man presented with a 16-year history of relapsing/remitting multiple sclerosis. For 1 year, the patient had been complaining of electric shock-like, paroxysmal pain of severe intensity that lasted from a fraction of a second to a few minutes and involved the first and second trigeminal divisions of both sides simultaneously. The neurophysiologic testing of trigeminal reflexes showed bilateral delayed latencies of reflex responses compatible with a trigeminal afferent pathway impairment related to multiple sclerosis. A dedicated 3T magnetic resonance imaging scan revealed pontine demyelinating plaque and a bilateral neurovascular conflict at the trigeminal root entry zone. The finding of an unusual case of simultaneous bilateral trigeminal neuralgia due to multiple sclerosis should prompt neurologists to consider a diagnosis of trigeminal neuralgia in patients with multiple sclerosis in cases of simultaneous involvement of trigeminal territories on both sides.
尽管有几项报告表明，多发性硬化症相关的三叉神经痛可能双侧发生于面颌区域，但三叉神经痛疼痛通常涉及两侧不同的时间间隔，两侧三叉神经区域的同时受累通常被认为不符合其诊断。本病例报告描述了一例双侧三叉神经痛相关的多发性硬化症，其起始于面颌区域的两侧同时发生。一位 55 岁的男性，患有复发性缓解型多发性硬化症 16 年。1 年来，患者一直抱怨电击样、阵发性剧痛，强度剧烈，持续时间从几分之一秒到几分钟不等，同时累及双侧第一和第二三叉神经分支。三叉神经反射的神经生理测试显示双侧反射反应延迟，与多发性硬化症相关的三叉神经传入通路损伤相符合。专门的 3T 磁共振成像扫描显示桥脑脱髓鞘斑块和双侧三叉神经根入口区的血管神经冲突。这种不常见的同时双侧三叉神经痛由于多发性硬化症的病例，应促使神经科医生在双侧三叉神经区域同时受累的情况下，考虑多发性硬化症患者同时发生三叉神经痛的诊断。
