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Neurological picture
Dorsolateral pontine segmental infarction presenting as isolated trigeminal sensory neuropathy
  1. KAZUHIRO ISHII,
  2. AKIRA TAMAOKA,
  3. SHIN’ICHI SHOJI
  1. Department of Neurology, Institute of Clinical Medicine, University of Tsukuba, Japan
  1. Dr Akira Tamaoka, Department of Neurology, Institute of Clinical Medicine, University of Tsukuba, 1–1–1 Tennoudai, Tsukuba, Ibaraki 305–0006, Japan.

https://doi.org/10.1136/jnnp.65.5.702

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    Small infarction in the left dorsolateral pontine tegmentum was identified by MRI in a 41 year old man presenting with isolated orofacial sensory deficits in the absence of other neurological findings.

     Isolated trigeminal sensory neuropathy resulting from brain stem vascular lesions, either haemorrhagic1 or ischaemic,2 3 has been extremely rarely reported.

    Our patient awoke to find numbness and paraesthesia over the left upper face, tongue, and buccal mucosa. Neurological examination disclosed non-dissociated sensory deficits on the same region. The corneal responsiveness was normal, and no hypotonus and weakness of the masseter muscle was detected. These findings implicated exclusive involvement of the pontine trigeminal sensory complex, including the principal sensory nucleus and pars oralis of the spinal trigeminal nucleus and tract.

    The figure shows (A) the coronal and (B) the axial T2 weighted images, with a hypointense lesion in the left dorsolateral pontine tegmentum a few days after the onset.

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      (1987) Lateral pontine segmental hemorrhage presenting as isolated trigeminal sensory neuropathy. Neurology 37:704–706.
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      (1990) Pontine infarction manifesting as isolated trigeminal sensory neuropathy. Neurol Med (Tokyo) 32:526–528.
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      (1996) Small medullary infarction presenting as painful trigeminal sensory neuropathy. J Neurol Neurosurg Psychiatry 61:138.
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