Plantone Domenico, Distaso Eugenio, D'Onghia Mariangela, Dell'Aquila Claudia, Giannini Antonio, Rinaldi Giuseppe
Azienda Sanitaria Locale della Provincia di Bari, Neurology Unit, Di Venere Teaching Hospital, Bari, Italy.
Azienda Sanitaria Locale della Provincia di Bari, Radiology Unit, Di Venere Teaching Hospital, Bari, Italy.
Neurohospitalist. 2022 Jan;12(1):143-146. doi: 10.1177/19418744211027754. Epub 2021 Aug 3.
Trigeminal neuralgia associated with brainstem lesions is currently considered as a rare condition and only few patients have been reported so far in literature. Tohyama and colleagues recently proposed the nosological entity of trigeminal neuralgia associated with solitary pontine lesion, trying to categorize it as a new clinical syndrome on its own. Based on this description, trigeminal neuralgia associated with solitary pontine lesion patients have an identical clinical presentation compared to other patients with trigeminal neuralgia but have a solitary pontine lesion. The nature of the pontine lesion has been attributed to several etiologies, including ischemia, demyelination or previous pontine viral neuritis. In those patients with a putative demyelinating lesion, a definite diagnosis of multiple sclerosis cannot be made due to the lack of dissemination in space. Very little is known in relation to the cerebrospinal fluid characteristics of this population of patients. We present a case of a 42-year-old man suffering of trigeminal neuralgia associated with solitary pontine lesion with a possible demyelinating etiology. The patient herein described had an atypical trigeminal neuralgia associated with a single pontine lesion. The MRI characteristics of the lesion, along with the presence of oligoclonal bands in the cerebrospinal fluid, suggested a demyelinating etiology. Trigeminal neuralgia associated with a solitary pontine lesion may be categorized as a possible manifestation of solitary sclerosis. Future research need to reveal which features can predict the risk of conversion to clinically defined multiple sclerosis and which treatments modify this risk.
与脑干病变相关的三叉神经痛目前被认为是一种罕见疾病，迄今为止文献中仅报道了少数患者。远山及其同事最近提出了与孤立性脑桥病变相关的三叉神经痛这一疾病实体，试图将其归类为一种独立的新临床综合征。基于这一描述，与孤立性脑桥病变相关的三叉神经痛患者与其他三叉神经痛患者具有相同的临床表现，但存在孤立性脑桥病变。脑桥病变的性质归因于多种病因，包括缺血、脱髓鞘或既往脑桥病毒性神经炎。在那些疑似脱髓鞘病变的患者中，由于缺乏空间播散，无法做出多发性硬化的确切诊断。关于这类患者的脑脊液特征，目前所知甚少。我们报告一例42岁男性患者，患有与孤立性脑桥病变相关的三叉神经痛，病因可能为脱髓鞘。本文描述的患者患有与单个脑桥病变相关的非典型三叉神经痛。病变的MRI特征以及脑脊液中寡克隆带的存在提示脱髓鞘病因。与孤立性脑桥病变相关的三叉神经痛可能被归类为孤立性硬化的一种可能表现。未来的研究需要揭示哪些特征可以预测转化为临床定义的多发性硬化的风险，以及哪些治疗方法可以改变这种风险。
