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Chronic neuropathic pain can result from nervous system injury and can persist in the absence of external stimuli. Although ongoing pain characterizes the disorder, in many individuals, the intensity of this ongoing pain fluctuates dramatically. Previously, it was identified that functional magnetic resonance imaging signal covariations between the midbrain periaqueductal gray (PAG) matter, rostral ventromedial medulla (RVM), and spinal trigeminal nucleus are associated with moment-to-moment fluctuations in pain intensity in individuals with painful trigeminal neuropathy (PTN). Since this brainstem circuit is modulated by higher brain input, we sought to determine which cortical sites might be influencing this brainstem network during spontaneous fluctuations in pain intensity. Over 12 min, we recorded the ongoing pain intensity in 24 PTN participants and classified them as fluctuating (n = 13) or stable (n = 11). Using a PAG seed, we identified connections between the PAG and emotional-affective sites such as the hippocampal and posterior cingulate cortices, the sensory-discriminative posterior insula, and cognitive-affective sites such as the dorsolateral prefrontal (dlPFC) and subgenual anterior cingulate cortices that were altered dependent on spontaneous high and low pain intensity. Additionally, sliding-window functional connectivity analysis revealed that the dlPFC-PAG connection anticorrelated with perceived pain intensity over the entire 12 min period. These findings reveal cortical systems underlying moment-to-moment changes in perceived pain in PTN, which likely cause dysregulation in the brainstem circuits previously identified, and consequently alter the appraisal of pain across time.

The temporomandibular joint (TMJ) consists of bone, cartilage, ligaments, and associated masticatory muscles and tendons that coordinate to enable mastication in mammals. The TMJ is innervated by the trigeminal nerve (CNV), containing axons of motor and somatosensory neurons. Somatosensation includes touch, temperature, proprioception, and pain that enables mammals to recognize and react to stimuli for survival. The somatosensory innervation of the TMJ remains poorly defined. Disorders of the TMJ (TMD) are of diverse etiology and presentation. Some known symptoms associated with TMD include facial, shoulder, or neck pain, jaw popping or clicking, headaches, toothaches, and tinnitus. Acute or chronic pain in TMD stems from the activation of somatosensory nociceptors. Treatment of TMD may involve over-the-counter and prescription medication, nonsurgical treatments, and surgical treatments. In many cases, treatment achieves only a temporary relief of symptoms including pain. We suggest that defining the sensory innervation of the temporomandibular joint and its associated tissues with a specific focus on the contribution of peripheral innervation to the development of chronic pain could provide insights into the origins of joint pain and facilitate the development of improved analgesics and treatments for TMD. [ABSTRACT FROM AUTHOR]

Background: Neuropeptides play a critical role in regulating pain and inflammation. Despite accumulating evidence has further uncovered the novel functions and mechanisms of different neuropeptides in orofacial pain sensation and transmission, there is deficient systematic description of neuropeptides' pain modulation in the orofacial region, especially in the trigeminal system. Objectives: The present review aims to summarise several key neuropeptides and gain a better understanding of their major regulatory roles in orofacial inflammation and pain. Methods: We review and summarise current studies related to calcitonin gene‐related peptide (CGRP), substance P (SP), opioid peptide (OP), galanin (GAL) and other neuropeptides' functions and mechanisms as well as promising targets for orofacial pain control. Results: A number of neuropeptides are clearly expressed in the trigeminal sensory system and have critical functions in the transduction and pathogenesis of orofacial pain. The functions, possible cellular and molecular mechanisms have been introduced and discussed. Neuropeptides and their agonists or antagonists which are widely studied to be potential treatment options of orofacial pain has been evaluated. Conclusions: Various neuropeptides play important but distinct (pro‐nociceptive or analgesic) roles in orofacial pain with different mechanisms. In summary, CGRP, SP, NPY, NKA, HK‐1, VIP mainly play proinflammatory and pro‐nociceptive effects while OP, GAL, OXT, OrxA mainly have inhibitory effects on orofacial pain. [ABSTRACT FROM AUTHOR]

Background: Nerve fibers related to pain and temperature sensation in the trigeminal nerve territory converge with the upper cervical spinal nerves from the level of the lower medulla oblongata to the upper cervical cord. This structure is called the trigemino‐cervical complex and may cause referred pain in the territory of the trigeminal or upper cervical spinal nerves. Case Series: Here, we report three cases of paroxysmal neuralgia in the occipital region with mild conjunctivitis or a few reddish spots in the ipsilateral trigeminal nerve territory. The patients exhibited gradual progression of these reddish spots evolving into vesicles over the course of several days, despite the absence of a rash in the occipital region. The patients were diagnosed with trigeminal herpes zoster and subsequently received antiherpetic therapy. Remarkably, the neuralgia in the occipital region showed gradual amelioration or complete resolution before the treatment, with no sequelae reported in the occipital region. Discussion: The trigemino‐cervical complex has the potential to cause neuralgia in the occipital region, as referred pain, caused by trigeminal herpes zoster. These cases suggest that, even if conjunctivitis or reddish spots appear to be trivial in the trigeminal nerve territory, trigeminal herpes zoster should be considered when neuralgia occurs in the ipsilateral occipital region. [ABSTRACT FROM AUTHOR]

Dysregulation of voltage-gated sodium NaV1.7 channels in sensory neurons contributes to chronic pain conditions, including trigeminal neuropathic pain. We previously reported that chronic pain results in part from increased SUMOylation of collapsin response mediator protein 2 (CRMP2), leading to an increased CRMP2/NaV1.7 interaction and increased functional activity of NaV1.7. Targeting this feed-forward regulation, we developed compound 194, which inhibits CRMP2 SUMOylation mediated by the SUMO-conjugating enzyme Ubc9. We further demonstrated that 194 effectively reduces the functional activity of NaV1.7 channels in dorsal root ganglia neurons and alleviated inflammatory and neuropathic pain. Here, we used a comprehensive array of approaches, encompassing biochemical, pharmacological, genetic, electrophysiological, and behavioral analyses, to assess the functional implications of NaV1.7 regulation by CRMP2 in trigeminal ganglia (TG) neurons. We confirmed the expression of Scn9a, Dpysl2, and UBE2I within TG neurons. Furthermore, we found an interaction between CRMP2 and NaV1.7, with CRMP2 being SUMOylated in these sensory ganglia. Disrupting CRMP2 SUMOylation with compound 194 uncoupled the CRMP2/NaV1.7 interaction, impeded NaV1.7 diffusion on the plasma membrane, and subsequently diminished NaV1.7 activity. Compound 194 also led to a reduction in TG neuron excitability. Finally, when intranasally administered to rats with chronic constriction injury of the infraorbital nerve, 194 significantly decreased nociceptive behaviors. Collectively, our findings underscore the critical role of CRMP2 in regulating NaV1.7 within TG neurons, emphasizing the importance of this indirect modulation in trigeminal neuropathic pain. [ABSTRACT FROM AUTHOR]

Toothache is one of the most common types of pain, but the mechanisms underlying pulpitis-induced pain remain unknown. The ionotropic purinergic receptor family (P2X) is reported to mediate nociception in the nervous system. This study aims to investigate the involvement of P2X3 in the sensitisation of the trigeminal ganglion (TG) and the inflammation caused by acute pulpitis. An acute tooth inflammation model was established by applying LPS to the pulp of SD rats. We found that the increased expression of P2X3 was induced by acute pulpitis. A selective P2X3 inhibitor (A-317491) reduced pain-like behavior in the maxillofacial region of rats and depressed the activation of neurons in the trigeminal ganglion induced by pulpitis. The upregulated MAPK signaling (p-p38, p-ERK1/2) expression in the ipsilateral TG induced by pulpitis could also be depressed by the application of the P2X3 inhibitor. Furthermore, the expression of markers of inflammatory processes, such as NF-κB, TNF-α and IL-1β, could be induced by acute pulpitis and deduced by the intraperitoneal injection of P2X3 antagonists. Our findings demonstrate that purinergic P2X3 receptor signaling in TG neurons contributes to pulpitis-induced pain in rats and that P2X3 signaling may be a potential therapeutic target for tooth pain. [ABSTRACT FROM AUTHOR]

Cervicogenic headache (CGH) is a common condition with a neuroanatomical basis involving the trigeminal nerve. Dry needling (DN) is a safe and effective treatment for CGH but most studies involve deep DN to cervical musculature. The aim of this study was to investigate immediate effects of superficial DN of the trigeminal nerve innervation field on numeric pain rating scale (NPRS), flexion-rotation test (FRT), cervical range of motion (AROM), and pain-pressure threshold (PPT) of right (R) and left (L) supraorbital (SO), and right (R) and left (L) greater occipital (GO) nerves in participants with CGH. A parallel controlled randomized design involving 30 participants with CGH received either superficial DN (N = 17) or sham DN (N = 13). Participants and outcome assessors were blind to group assignment. Wilcoxon signed rank analyzed within-group effects and Mann–Whitney U analyzed between-group. Statistically significant between-group differences were observed for NPRS (P <.001) and AROM (P <.006) favoring DN and were clinically meaningful. Right and left Flexion rotation tests (FRT) outcomes were non-significant (P =.137) but clinically meaningful. No differences were observed for PPT over: R SO (P =.187); L SO (P =.052); R GO (P =.187); or L GO (P =.052). Between-group effect sizes across variables were moderate to large (0.53–1.4) but confidence intervals were wide. Superficial DN targeting the innervation field of the trigeminal nerve improves clinical outcomes in patients with CGH. Only the immediate effects were analyzed and the sample size was small. Larger, longer-term assessments are needed comparing superficial DN of the trigeminal innervation field and other conservative interventions for CGH. [ABSTRACT FROM AUTHOR]

Meckel’s cave tumour, a rare benign tumour originating from the Schwann cells surrounding the trigeminal nerve within the Meckel’s cave region, can present with a variety of clinical manifestations. We report a case of a 44-year-old male patient who presented with symptoms of tear deficiency, including dryness, ocular discomfort, and blurred vision. Diagnostic evaluation revealed the presence of a Meckel’s cave tumour harming the trigeminal nerve, leading to alacrimia. This case highlights the association between Meckel’s cave tumour and tear deficiency disorders.

The article describes the case of a 14-year-old female with a history of rapidly growing right cheek mass and was diagnosed of adamantinoma-like Ewing sarcoma (ALES). Topics discussed include clinical characteristics of Ewing sarcoma (ES), the discovery of other soft tissue tumors that share a translocation between the EWSR1 gene and the ETS gene family, and treatment for most pediatric parotid tumors.

Amyloidosis is a systemic disease characterized by the accumulation of amyloid protein in multiple organs. Amyloidoma, in contrast, is an uncommon localized form of amyloidosis that presents as a single mass or tumor-like lesion. Primary amyloidoma in the central nervous system is rare, and only a few cases have been reported. Notably, the Gasserian ganglion is the most frequently affected site of amyloidoma in the central nervous system, and progressive trigeminal neuropathy is a characteristic finding. Among these cases, the bilateral occurrence of amyloidoma is exceedingly rare. In this report, we present the case of a 51-year-old woman diagnosed with bilateral trigeminal amyloidoma, confirmed by an endoscopic biopsy via the transsphenoidal approach. [ABSTRACT FROM AUTHOR]

Background: Motor cortex stimulation (MCS) represents a treatment option for refractory trigeminal neuralgia (TGN). Usually, patients need to be awake during surgery to confirm a correct position of the epidural electrode above the motor cortex, reducing patient's comfort. Method: Epidural cortical mapping (ECM) and motor evoked potentials (MEPs) were intraoperatively performed for correct localization of motor cortex under general anesthesia that provided comparable results to test stimulation after letting the patient to be awake during the operation. Conclusion: Intraoperative ECM and MEPs facilitate a confirmation of correct MCS-electrode position above the motor cortex allowing the MCS-procedure to be performed under general anesthesia. [ABSTRACT FROM AUTHOR]

This scientific letter discusses a case of trigeminal neuropathy in a 16-year-old patient with pediatric-onset mixed connective tissue disease (MCTD). Trigeminal neuropathy is a rare symptom in childhood that can be caused by various factors, including connective tissue diseases. The patient in this case responded well to treatment with corticosteroids and hydroxychloroquine, and the symptoms completely regressed. The study highlights the importance of considering rheumatologic diseases in the diagnosis of trigeminal neuropathy and emphasizes the need for early diagnosis and treatment. [Extracted from the article]

The infraorbital nerve is responsible for the sensory innervation of the lower eyelid, the lateral nose, the cheek, the upper lip, and the maxillary teeth. It passes along the infraorbital canal, which runs superior to the maxillary sinus. Dehiscence of the infraorbital canal and its ectopic course in the maxillary sinus is a rare variation. A nerve with these variations may be affected by pathologies in the maxillary sinus and this may constitute a rare cause of facial pain. In this report, we present the clinical symptoms of a 29-year-old male patient who had an infraorbital nerve with an ectopic course and dehiscence in light of the literature.

The infraorbital nerve is responsible for the sensory innervation of the lower eyelid, the lateral nose, the cheek, the upper lip, and the maxillary teeth. It passes along the infraorbital canal, which runs superior to the maxillary sinus. Dehiscence of the infraorbital canal and its ectopic course in the maxillary sinus is a rare variation. A nerve with these variations may be affected by pathologies in the maxillary sinus and this may constitute a rare cause of facial pain. In this report, we present the clinical symptoms of a 29-year-old male patient who had an infraorbital nerve with an ectopic course and dehiscence in light of the literature. [ABSTRACT FROM AUTHOR]

Trigeminal trophic syndrome (TTS) is a rare condition resulting from self‐manipulation of the skin after an injury to the trigeminal nerve. We describe the case of a 70‐year‐old woman who was hospitalized because of erythema, ulceration, and crusts on the right side of her face, accompanied by itching, burning, and irritation forcing self‐manipulation of the skin. She had been previously repeatedly treated with antibiotics, acyclovir, and topical medications without any improvement. Her medical history revealed an episode of ischemic stroke in 2016, after which a deformation and partial atrophy of the right ala nasi appeared. Trigeminal neuropathy was confirmed by a neurological consultation. Diagnosis and treatment of TTS requires a multidisciplinary approach. Awareness of this disease should be raised to enable proper diagnosis and management of difficult‐to‐treat facial ulcers that cannot be explained by common causes. [ABSTRACT FROM AUTHOR]

Background: Postoperative trigeminal neuropathy may be seen after surgery for middle and posterior cranial fossa lesions. Although neuropathic pain is a cause of reduced quality of life, global consensus on postoperative pain management is lacking. Mirogabalin besylate is a selective ligand for the α2δ subunit of voltage-gated calcium channels. Although mirogabalin has been used for patients with postherpetic neuralgia and painful diabetic peripheral neuropathy, few reports have assessed the effect on postsurgical neuropathy. In this report, we describe a clinical effectiveness of mirogabalin for trigeminal neuropathy after skull base surgery. Case description: Case 1: A 51-year-old female with right trigeminal schwannoma was operated on via the anterior transpetrosal approach. She had tingling and numb feelings in the right face postoperatively. Mirogabalin was orally administered after the operation. Her continuous facial numbness immediately improved. Case 2: A 55-year-old female with left middle fossa base meningioma extending into the infratemporal fossa was operated on via the infratemporal fossa approach. She had a tingling feeling in the left face postoperatively. Mirogabalin was orally administered for this symptom after the operation, which gradually improved. Conclusions: Mirogabalin may show significant pain relief for patients with trigeminal neuropathy after skull base surgery. Further studies using a larger number of patients are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives: The detailed pathological mechanism of orofacial neuropathic pain remains unknown. We aimed to examine the pannexin 1 (Panx1) signaling in the trigeminal ganglion (TG) involvement in infraorbital nerve injury (IONI)‐induced orofacial neuropathic pain. Materials and Methods: Mechanical head‐withdrawal threshold (MHWT) was measured in IONI‐treated rats receiving intra‐TG Panx1 inhibitor or metabotropic glutamate receptor 5 (mGluR5) antagonist administration and MHWTs in naive rats receiving intra‐TG mGluR5 agonist administration post‐IONI. Glutamate and Panx1 in the TG were measured post‐IONI. Panx1, mGluR5, and glutamine synthetase expression in TG were immunohistochemically identified, and changes in the number of mGluR5‐P2X3‐expressed TG neurons were examined. Results: MHWT was significantly decreased post‐IONI, and this decrease was reversed by Panx1 inhibition or mGluR5 antagonism. mGluR5 agonism induced a decrease in the MHWT. IONI increased extracellular glutamate in TG. Panx1 was expressed in satellite glial cells and TG neurons, and intra‐TG mGluR5 antagonism decreased the number of mGluR5 and P2X3 positive TG neurons post‐IONI. Conclusions: IONI facilitates glutamate release via Panx1 that activates mGluR5 which was expressed in the nociceptive TG neurons innervating the orofacial region. In turn, P2X3 receptor‐expressed TG neurons are enhanced via mGluR5 signaling, resulting in orofacial neuropathic pain. [ABSTRACT FROM AUTHOR]

PURPOSE:To evaluate the efficacy and safety of topical cenegermin (recombinant human nerve growth factor) in patients with neurotrophic keratopathy. DESIGN:Multicenter, randomized, double-masked, vehicle-controlled trial. PARTICIPANTS:Patients with neurotrophic persistent epithelial defect with or without stromal thinning. METHODS:The NGF0214 trial, conducted among 11 sites in the United States, randomized 48 patients 1:1 to cenegermin 20 μg/ml or vehicle eye drops, 6 drops daily for 8 weeks of masked treatment. Follow-up was 24 weeks. Safety was assessed in all patients who received study drug. Efficacy was assessed by intention to treat. MAIN OUTCOME MEASURES:The primary end point was healing of the neurotrophic lesion (persistent epithelial defect or corneal ulcer) after 8 weeks of masked treatment. Masked central readers measured neurotrophic lesions in randomized clinical pictures, then assessed healing status conventionally (

Trigeminal neuralgia is a neuropathic disease characterized by severe pain that reduces the patient's quality of life. This case report presents a Coronavirus Disease 2019 (COVID-19) positive case whose only neurological symptom is trigeminal neuralgia. A 59-year-old male patient with complaints of weakness, joint pain, cough, and respiratory failure was diagnosed with COVID-19. The patient was started on COVID-19 treatment and quarantined. Severe pain occurred on the right side of the patient's face on the third day of the onset of COVID-19-related complaints. There was severe pain in the distribution region of the maxillary and mandibular nerves, occurring 10-20 times a day and lasting 1-2 minutes. The patient was diagnosed with trigeminal neuralgia, and carbamazepine was started. Within three days, a significant decrease was observed in the complaint of pain. It should be kept in mind that SARS-CoV-2 may cause trigeminal neuralgia by activating the trigeminal nerve. [ABSTRACT FROM AUTHOR]

A solitary pontine lesion (SPL) is a single brainstem lesion on the trigeminal nerve pathway without any other central nervous system lesion. This research aimed to investigate the demographic and clinical features of nonpainful TNO patients with SPL and identify the most frequently affected anatomical areas using lesion mapping techniques. Demographic and clinical features were retrospectively reviewed from the patients' charts. Brain lesions were mapped using MRIcroGL software. The study included 6 patients (three females and three males) with an SPL. The median age of the patients was 57 (range: 46–68) years. Cranial MRI displayed lesions in the dorsolateral pons and the cerebellar peduncle. The lesion mapping revealed that the lesions were on the trigeminal nerve pathway. SPL is an uncommon cause of TNO. Nonpainful SPL patients have demographic, clinical, and radiological features similar to those of painful SPL patients. The lesion mapping showed that the same brainstem areas are affected in painful and nonpainful SPL patients. [ABSTRACT FROM AUTHOR]

Post-traumatic trigeminal neuropathic pain (PTNP) combined with secondary dystonia are rare sequelae of orofacial injury and often do not respond to conservative treatment. The consensus on treatment for both symptoms is yet to be standardized. This study reports the case of a 57-year-old male patient with left orbital trauma who developed PTNP immediately after the injury and secondary hemifacial dystonia 7 months thereafter. To treat his neuropathic pain, we performed peripheral nerve stimulation (PNS) using a percutaneously implanted electrode to the ipsilateral supraorbital notch along the brow arch, which instantly resolved the patient's pain and dystonia. PTNP was relieved in a satisfactory manner until 18 months after the surgery, despite a gradual recurrence of the dystonia since 6 months after the surgery. To the best of our knowledge, this is the first reported case of PNS used for the treatment of PTNP combined with dystonia. This case report highlights the potential benefits of PNS in relieving neuropathic pain and dystonia and discusses the underlying therapeutic mechanism. Moreover, this study suggests that secondary dystonia occurs due to the uncoordinated integration of afferent sensory and efferent motor information. The findings of the present study indicate that PNS should be considered for patients with PTNP following the failure of conservative treatment. Secondary hemifacial dystonia may benefit from PNS upon further research and long-term assessment. [ABSTRACT FROM AUTHOR]

Background: Trigeminal neuralgia (TN) is a painful disease of the trigeminal nerve, triggered by chewing or manipulating the gums. It is urgent for the dentist to be aware of this pathology of non-odontogenic pain, avoiding root canals and extractions for proper interconsultation with neurology and neurosurgery. Purpose: To identify the most common etiology of TN in patients treated at EsSalud Cusco from January 2019 to August 2022. Method: Observational type, descriptive and retrospective design; the calculated sample of 127 medical records was obtained according to inclusive criteria; the instrument validated by specialists, computerized data from medical records; the variables, measured in data collection sheets by a single evaluator in an Excel sheet. For the most common etiology variable, the scores were according to predisposing factors and etiological factors; while for the NT variable, according to the types of NT and pain scales, both measured by international standards. Finally, the type of analysis was descriptive statistics, the score relationship thanks to Pearson's partial correlation coefficient, and interpreted according to Cohen's Kappa values. Results: Most common etiology variable: Predisposing factor, sex at 79.5 % and as an etiological factor, unknown etiology at 55.1 %. Variable NT: idiopathic type at 34.6 %; according to the EVA scale, of intense pain at 59.1 %. Conclusion: According to chi-square 879, the average relationship of the most common etiology of NT has sex as a predisposing factor, being female the most affected at 79.5 %; and unknown etiology as an etiological factor in 55.1 %. [ABSTRACT FROM AUTHOR]

Trigeminal neuralgia (TN) is a chronic pain condition causing lancinating pain in the distribution of one or more divisions of the trigeminal nerve. Gamma knife stereotactic radiosurgery (GKSRS) is a surgical option for TN refractory to medical therapy. To report our experience and to analyze the reasons for the variance in radiosurgery outcomes between patients in our diverse population, we conducted a retrospective analysis of a prospectively created database. The 178 patients completed a pain assessment questionnaire before surgery, and at 1 and 2 year follow-ups. We used the "Trigeminal Neuralgia Gamma Knife Outcome Scale" (TN GKOS) to report the response. At 1-year, 35.4% of patients had grade 1A outcome (pain-free and off all pain medications), 24.7% had grade 1B (pain-free on pain medications), 24.2% had grade 1C (some pain but improved with radiosurgery), 12.9% had grade 2 (same as before radiosurgery) and 2.8% had grade 3 (worse pain compared to before radiosurgery). At 2 years, 42.3% had grade 1A, 20.5% had grade 1B, 19.2% had grade 1C, 14.1% had grade 2 and 3.8% had grade 3 outcome. Remarkably, a statistically significant association was found between GKOS and age, racial background and obesity. [ABSTRACT FROM AUTHOR]

Purpose: Benign triton tumors (BTTs) in the pediatric population are extremely rare occurrences. Paucity of data on BTTs poses both diagnostic and therapeutic challenges, particularly when found intracranially. Methods: A case report of a 10-year-old male diagnosed with incidental maxillary trigeminal (V2) BTT is presented. We discuss radiographic and histopathological interpretations. Furthermore, we provide a brief review of current literature and historical background on pediatric trigeminal BTT diagnosis, histopathology, and management. Results: Successful gross total resection of the tumor was achieved via Dolenc approach to the cavernous sinus. Management options with consideration of outcomes from the few prior cases reported in the literature are presented. Conclusion: Treatment of trigeminal nerve tumors requires a broad differential diagnosis and understanding rare tumors is essential in the diagnosis and treatment algorithm. [ABSTRACT FROM AUTHOR]

Background: Cranial neuropathy is a principal disease manifestation of neurosarcoidosis, but many forms remain poorly described, including trigeminal nerve disease despite its frequency in reported cohorts (5–12%). Herein, we characterize the clinical course of patients with neurosarcoidosis involving the trigeminal nerve.A single-center retrospective cohort analysis of patients with biopsy-proven sarcoidosis involving the trigeminal nerve was conducted between 1/1/2000-3/7/2023.The trigeminal nerve was affected in 14/245 (5.7%) patients, being clinically symptomatic in 5/245 (2.0%) and asymptomatic with radiographic involvement in 9/245 (3.7%). 14/14 (100.0%) patients had systemic sarcoidosis. In the symptomatic group, trigeminal neuropathy was an inaugural feature in 4/5 (80.0%), unilateral in 5/5 (100.0%) with the V1 subdivision most affected (4/5, 80.0%), and associated with neuralgia in 2/5 (40.0%). On MRI, the cisternal nerve roots (9/14, 64.3%), Meckel’s cave (7/14, 50.0%), and cavernous sinus (5/14, 35.7%) were most commonly affected, and 14/14 (100.0%) patients had extra-trigeminal neuroinflammation on cranial MRI. CSF was abnormal in at least one dimension in 11/12 (91.7%) tested. All three treated patients with symptomatic trigeminal neuropathy responded to immunomodulatory treatment, and symptomatic treatments for trigeminal neuralgia were helpful in two patients. After a median follow-up period of 63 months, the median modified Rankin scale score was 1 for both subgroups.Neurosarcoidosis may involve any portion of the trigeminal apparatus, and when affected, it frequently demonstrates a mismatch in radiographic involvement from its clinical manifestations of facial numbness and pain, and typically occurs in association with other clinical or radiographic manifestations of neurosarcoidosis.Methods: Cranial neuropathy is a principal disease manifestation of neurosarcoidosis, but many forms remain poorly described, including trigeminal nerve disease despite its frequency in reported cohorts (5–12%). Herein, we characterize the clinical course of patients with neurosarcoidosis involving the trigeminal nerve.A single-center retrospective cohort analysis of patients with biopsy-proven sarcoidosis involving the trigeminal nerve was conducted between 1/1/2000-3/7/2023.The trigeminal nerve was affected in 14/245 (5.7%) patients, being clinically symptomatic in 5/245 (2.0%) and asymptomatic with radiographic involvement in 9/245 (3.7%). 14/14 (100.0%) patients had systemic sarcoidosis. In the symptomatic group, trigeminal neuropathy was an inaugural feature in 4/5 (80.0%), unilateral in 5/5 (100.0%) with the V1 subdivision most affected (4/5, 80.0%), and associated with neuralgia in 2/5 (40.0%). On MRI, the cisternal nerve roots (9/14, 64.3%), Meckel’s cave (7/14, 50.0%), and cavernous sinus (5/14, 35.7%) were most commonly affected, and 14/14 (100.0%) patients had extra-trigeminal neuroinflammation on cranial MRI. CSF was abnormal in at least one dimension in 11/12 (91.7%) tested. All three treated patients with symptomatic trigeminal neuropathy responded to immunomodulatory treatment, and symptomatic treatments for trigeminal neuralgia were helpful in two patients. After a median follow-up period of 63 months, the median modified Rankin scale score was 1 for both subgroups.Neurosarcoidosis may involve any portion of the trigeminal apparatus, and when affected, it frequently demonstrates a mismatch in radiographic involvement from its clinical manifestations of facial numbness and pain, and typically occurs in association with other clinical or radiographic manifestations of neurosarcoidosis.Results: Cranial neuropathy is a principal disease manifestation of neurosarcoidosis, but many forms remain poorly described, including trigeminal nerve disease despite its frequency in reported cohorts (5–12%). Herein, we characterize the clinical course of patients with neurosarcoidosis involving the trigeminal nerve.A single-center retrospective cohort analysis of patients with biopsy-proven sarcoidosis involving the trigeminal nerve was conducted between 1/1/2000-3/7/2023.The trigeminal nerve was affected in 14/245 (5.7%) patients, being clinically symptomatic in 5/245 (2.0%) and asymptomatic with radiographic involvement in 9/245 (3.7%). 14/14 (100.0%) patients had systemic sarcoidosis. In the symptomatic group, trigeminal neuropathy was an inaugural feature in 4/5 (80.0%), unilateral in 5/5 (100.0%) with the V1 subdivision most affected (4/5, 80.0%), and associated with neuralgia in 2/5 (40.0%). On MRI, the cisternal nerve roots (9/14, 64.3%), Meckel’s cave (7/14, 50.0%), and cavernous sinus (5/14, 35.7%) were most commonly affected, and 14/14 (100.0%) patients had extra-trigeminal neuroinflammation on cranial MRI. CSF was abnormal in at least one dimension in 11/12 (91.7%) tested. All three treated patients with symptomatic trigeminal neuropathy responded to immunomodulatory treatment, and symptomatic treatments for trigeminal neuralgia were helpful in two patients. After a median follow-up period of 63 months, the median modified Rankin scale score was 1 for both subgroups.Neurosarcoidosis may involve any portion of the trigeminal apparatus, and when affected, it frequently demonstrates a mismatch in radiographic involvement from its clinical manifestations of facial numbness and pain, and typically occurs in association with other clinical or radiographic manifestations of neurosarcoidosis.Conclusion: Cranial neuropathy is a principal disease manifestation of neurosarcoidosis, but many forms remain poorly described, including trigeminal nerve disease despite its frequency in reported cohorts (5–12%). Herein, we characterize the clinical course of patients with neurosarcoidosis involving the trigeminal nerve.A single-center retrospective cohort analysis of patients with biopsy-proven sarcoidosis involving the trigeminal nerve was conducted between 1/1/2000-3/7/2023.The trigeminal nerve was affected in 14/245 (5.7%) patients, being clinically symptomatic in 5/245 (2.0%) and asymptomatic with radiographic involvement in 9/245 (3.7%). 14/14 (100.0%) patients had systemic sarcoidosis. In the symptomatic group, trigeminal neuropathy was an inaugural feature in 4/5 (80.0%), unilateral in 5/5 (100.0%) with the V1 subdivision most affected (4/5, 80.0%), and associated with neuralgia in 2/5 (40.0%). On MRI, the cisternal nerve roots (9/14, 64.3%), Meckel’s cave (7/14, 50.0%), and cavernous sinus (5/14, 35.7%) were most commonly affected, and 14/14 (100.0%) patients had extra-trigeminal neuroinflammation on cranial MRI. CSF was abnormal in at least one dimension in 11/12 (91.7%) tested. All three treated patients with symptomatic trigeminal neuropathy responded to immunomodulatory treatment, and symptomatic treatments for trigeminal neuralgia were helpful in two patients. After a median follow-up period of 63 months, the median modified Rankin scale score was 1 for both subgroups.Neurosarcoidosis may involve any portion of the trigeminal apparatus, and when affected, it frequently demonstrates a mismatch in radiographic involvement from its clinical manifestations of facial numbness and pain, and typically occurs in association with other clinical or radiographic manifestations of neurosarcoidosis. [ABSTRACT FROM AUTHOR]

The article focuses on the crucial role of Magnetic Resonance Imaging Neurography (MRIN) in evaluating facial pain related to trigeminal nerve lesions. Topics discussed include the safety and effectiveness of MRIN, its application in assessing posttraumatic neuropathy, and the need for standardized protocols in future studies to evaluate its impact on clinical practice.

Objective: Rare coexistence of disease or pathology Background: Bell’s palsy, also called facial nerve palsy, occasionally co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell’s palsy has a proposed viral etiology, in particular when occurring after dental manipulation. Case Report: A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell’s palsy. Including the current case, 85% of these patients also had pain in the face or neck. Conclusions: This case illustrates improvement of Bell’s palsy and concurrent trigeminal neuropathy with multimodal chiropractic care including spinal manipulation. Limited evidence from other similar cases suggests a role of the trigeminal pathway in these positive treatment responses of Bell’s palsy with concurrent face/neck pain. These findings should be explored with research designs accounting for the natural history of Bell’s palsy. [ABSTRACT FROM AUTHOR]

Background: Trigeminal neuropathy is characterized by numbness in the region innervated by the trigeminal nerves, with or without neuropathic weakness in the muscles of mastication. Trigeminal neuritis is a form of trigeminal neuropathy in which the lesion is caused by an inflammation. Herein, we report a patient with trigeminal neuritis due to central nervous system (CNS) involvement of herpes labialis (HL) infection, which was successfully treated with anti-viral and anti-inflammatory agents.Case Presentation: A young healthy female presented with numbness in the left hemiface for two weeks. She had a preceding typical HL infection on left facial lip one week before the sensory symptom onset. Brain magnetic resonance imaging revealed high signal intensities and asymmetrical thickening with enhancement along the cisternal segment of the left trigeminal nerve. Additionally, brain MR angiography showed multifocal stenoses in the M1 segment of the middle cerebral artery and the cavernous portion of the internal carotid artery. Cerebrospinal fluid (CSF) examination showed mild pleocytosis with normal protein level, glucose ratio, but CSF polymerase chain reaction assay for specific anti-viral antibodies including herpes simplex virus was negative, and CSF culture also did not identify a specific pathogen. The results of serologic testing including tumor markers and autoimmune markers were all unremarkable. A tentative diagnosis of trigeminal neuritis as a complication of HL involving the CNS was made considering the clinical, neuroradiological, and laboratory findings of the patient. Therefore, the patient was treated with intravenous methylprednisolone and acyclovir for 10 days. After the treatments, her sensory disturbance was markedly improved. Brain MRI at the 3-month follow-up also demonstrated improvement of previously identified high signal intensity lesions and multifocal intracerebral artery stenoses.Conclusion: HL is usually a self-limiting, benign disease without complications, but rarely presents as trigeminal neuritis due to CNS involvement. Therefore, meticulous evaluation may be necessary if trigeminal neuritis or CNS involving symptoms occur after HL. [ABSTRACT FROM AUTHOR]

Impairment in trigeminal nerve function causes a loss of corneal sensation and can lead to neurotrophic keratitis (NK). This gradual deterioration in the surface integrity of the cornea predisposes to the development of ulcers and may even progress to perforation, posing a risk for profound vision loss. Many common ophthalmic and systemic conditions, such as herpetic infections, ocular surgeries, neurosurgical procedures, multiple sclerosis and diabetes, can elicit NK by injuring the trigeminal nerve. Disease progression can occur rapidly and without symptoms, therefore, detecting NK early is critical. Management aims to halt continuing corneal damage and promote epithelial cell healing and nerve fibre regeneration. Novel treatment options show promise in restoring corneal sensitivity by re-establishing innervation, targeting the fundamental source of NK. [ABSTRACT FROM AUTHOR]

Trigeminal schwannoma is a neurogenic tumor of the fifth cranial nerve. Despite the advances in surgical practice, stereotactic radiosurgery is an alternative treatment in the management of these patients due to problems such as nerve injuries and tumor accessibility The patient was admitted to our hospital with complaints of headache and tingling in the left face for the last few months. The patient was discussed in the neurooncology council and surgical intervention was not considered, and radiotherapy was decided. Radiotherapy was planned in the Elekta Versa HD MONACO v.5.51 treatment planning system. 14 Gy/1 fr stereotactic radiosurgery was performed. The patient completed stereotactic radiosurgery treatment without complications. In the follow-up, 7 mm peripheral contrast-enhanced solid components with central necrosis was observed in the gadolinum MRI taken. Stereotactic radiosurgery is an effective and powerful method for trigeminal schwannomas. [ABSTRACT FROM AUTHOR]

Background: Data on the outcomes of microsurgical resection (SR) and stereotactic gamma knife radiosurgery (GKRS) in patients with trigeminal neuralgia associated with small petrous apex meningiomas are scarce.Objective: We conducted this study to evaluate the pain relief, tumor control, and procedure costs following SR and GKRS for small petroclival meningiomas (less than 3 cm in maximal diameter) using real-world data from our center in Egypt.Material and Methods: We conducted a retrospective cohort study of 47 patients with small petrous apex meningiomas presenting with intractable trigeminal nerve pain (SR: n = 22 and GKRS: n = 25). Data regarding pain relief on Barrow Neurological Institute (BNI), procedure cost, and tumor control were retrieved and analyzed using appropriate statistical tests.Results: Patients who underwent SR had lower median BNI pain intensity scores compared to those patients who underwent GKRS, and a significantly higher proportion of patients in the SR group had good BNI scores compared to those in GKRS group (P < 0.05); however, the total costs of SR were significantly less than GKRS (30,519$ vs. 92,372$, respectively).Conclusion: Both SR and GKRS provide pain relief and tumor control in patients with trigeminal neuralgia associated with petrous apex meningioma. However, in the present study, SR achieved better pain control and was more affordable than GKRS. [ABSTRACT FROM AUTHOR]

Introduction: Intradural, extra-axial cerebral cavernous malformations (CCMs) are rare entities and are mostly reported in relation to the optic apparatus or the facial/vestibulocochlear complex. Cranial nerve CCMs tend to follow a clinically aggressive course, with a tendency to progressive neurological dysfunction following intra-lesional haemorrhage or less commonly due to the effects of subarachnoid haemorrhage. Case Presentation: We report the first case of a trigeminal CCM presenting in a child with otalgia and left-sided headaches. The patient was initially managed with radiological surveillance but required surgical management following deterioration. We describe the successful treatment of the lesion with microsurgical resection. Conclusion: A CCM should be considered in the differential diagnosis of mass lesions arising in the region of the trigeminal nerve. Surgical resection is recommended to prevent neurological deterioration and may result in significant symptomatic improvement. [ABSTRACT FROM AUTHOR]