Author(s): V. Pizza, E. Lamaida, A. Agresta, G. Bandieramonte, A. Volpe, R. Galasso, L. Galasso, A. Bisogno, A. Capasso
Brain stem lesions are known to cause facial pain. But, trigeminal neuralgia (TN) due to ischemic lesion of the pons are very rare. We report a case with a pontine infarct at the root entry zone (REZ) of the right trigeminal nerve resulting with a classical trigeminal neural-gia. C.M.A. is an old woman (75 years) that suddenly presented an acute symptomatology typical of classical trigeminal neuralgia. Neurological examination revelead only slight hypoesthesia on the right V2 dermatomes. There was a trigger point at the right upper lip. Magnetic Resonance cranial investigation showed a hyperintesity in the FLAIR and DP/T2 and a hypontensity in T1 sequences latero-pontine dx, at the root entry zone (REZ) of the right trigeminal nerve. The patients was treated with pregabalin at dosage of 150 mg/die/os in two administrations and antiaggregant drugs. The resolution of symptomatology was reg-istered later three weeks. Isolated trigeminal neuralgia is a rare debut form of pontine in-farct and the mechanism of TN in these cases is still a matter of debate. Central theories on the etiology of TN mainly focus on the increased neuronal activity in the trigeminal nucleus. The treatment of secondary TN is a symptomatic control of pain with anti-epileptic agents. Besides, in a patient with pontine infarct, prevention of further strokes should be done. In our patient was obtained a complete resolution of the symptomatology with pregabalin and was effected a preventive stroke therapy with acetilsalicilic acid.