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Isolated trigeminal nerve palsy with motor involvement as a presenting manifestation of multiple sclerosis in an equatorial region - a case report.

Ratnayake EC, Caldera M, Perera P, Gamage R - Int Arch Med (2012)

Bottom Line: Involvement of the trigeminal nerve, particularly its motor component as part of a clinically isolated syndrome of multiple sclerosis has rarely been reported in equatorial regions and no cases have been described in Sri Lanka thus far.Clinicians should have a high index of suspicion when evaluating such patients especially in low prevalence regions close to the equator.Early recognition and treatment of such a "Clinically Isolated Syndrome" may prevent early relapse.

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Affiliation: Institute of Neurology, The National hospital of Sri Lanka, (Regent Street), Colombo, Sri Lanka. chamara.ratnayake@gmail.com.

ABSTRACT

Introduction: Isolated cranial nerve palsies are considered to be an uncommon presenting feature of multiple sclerosis. Involvement of the trigeminal nerve, particularly its motor component as part of a clinically isolated syndrome of multiple sclerosis has rarely been reported in equatorial regions and no cases have been described in Sri Lanka thus far.

Case presentation: We report a case of isolated right sided trigeminal nerve palsy (Motor and Sensory) in a 34 year old previously well lady from urban Sri Lanka who was found to have characteristic lesions on Magnetic Resonance Imaging highly suggestive of multiple sclerosis.

Conclusions: Multiple sclerosis should be considered in the differential diagnosis of patients who present with isolated cranial nerve palsies. Clinicians should have a high index of suspicion when evaluating such patients especially in low prevalence regions close to the equator. Early recognition and treatment of such a "Clinically Isolated Syndrome" may prevent early relapse.

No MeSH data available.


Related in: MedlinePlus

Close up image of T2WI MRI Brain image of multiple periventricular hyperintense lesions.
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Figure 3: Close up image of T2WI MRI Brain image of multiple periventricular hyperintense lesions.

Mentions: Magnetic Resonance Imaging (MRI) of the brain and spinal cord was subsequently performed and it revealed multiple, hyperintense (Both T2WI and T2 FLAIR), periventricular lesions in the deep white matter conforming to the characteristic Dawson’s Finger appearance which is highly suggestive of multiple sclerosis (Figures 2-3). There were also similar lesions in the right cerebellar peduncle. The spinal cord was free of lesions. Cerebrospinal fluid analysis revealed normal protein levels with no cells. The presence of oligoclonal bands could not be analyzed as this facility is unavailable at our institution and was unaffordable to the patient to be done in the private sector. Visual and Brainstem evoked potential studies were carried out and revealed normal results. All other basic biochemistry results were normal including normal inflammatory markers.


Isolated trigeminal nerve palsy with motor involvement as a presenting manifestation of multiple sclerosis in an equatorial region - a case report.

Ratnayake EC, Caldera M, Perera P, Gamage R - Int Arch Med (2012)

Close up image of T2WI MRI Brain image of multiple periventricular hyperintense lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3403846&req=5

Figure 3: Close up image of T2WI MRI Brain image of multiple periventricular hyperintense lesions.
Mentions: Magnetic Resonance Imaging (MRI) of the brain and spinal cord was subsequently performed and it revealed multiple, hyperintense (Both T2WI and T2 FLAIR), periventricular lesions in the deep white matter conforming to the characteristic Dawson’s Finger appearance which is highly suggestive of multiple sclerosis (Figures 2-3). There were also similar lesions in the right cerebellar peduncle. The spinal cord was free of lesions. Cerebrospinal fluid analysis revealed normal protein levels with no cells. The presence of oligoclonal bands could not be analyzed as this facility is unavailable at our institution and was unaffordable to the patient to be done in the private sector. Visual and Brainstem evoked potential studies were carried out and revealed normal results. All other basic biochemistry results were normal including normal inflammatory markers.

Bottom Line: Involvement of the trigeminal nerve, particularly its motor component as part of a clinically isolated syndrome of multiple sclerosis has rarely been reported in equatorial regions and no cases have been described in Sri Lanka thus far.Clinicians should have a high index of suspicion when evaluating such patients especially in low prevalence regions close to the equator.Early recognition and treatment of such a "Clinically Isolated Syndrome" may prevent early relapse.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Neurology, The National hospital of Sri Lanka, (Regent Street), Colombo, Sri Lanka. chamara.ratnayake@gmail.com.

ABSTRACT

Introduction: Isolated cranial nerve palsies are considered to be an uncommon presenting feature of multiple sclerosis. Involvement of the trigeminal nerve, particularly its motor component as part of a clinically isolated syndrome of multiple sclerosis has rarely been reported in equatorial regions and no cases have been described in Sri Lanka thus far.

Case presentation: We report a case of isolated right sided trigeminal nerve palsy (Motor and Sensory) in a 34 year old previously well lady from urban Sri Lanka who was found to have characteristic lesions on Magnetic Resonance Imaging highly suggestive of multiple sclerosis.

Conclusions: Multiple sclerosis should be considered in the differential diagnosis of patients who present with isolated cranial nerve palsies. Clinicians should have a high index of suspicion when evaluating such patients especially in low prevalence regions close to the equator. Early recognition and treatment of such a "Clinically Isolated Syndrome" may prevent early relapse.

No MeSH data available.


Related in: MedlinePlus