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Isolated hypesthesia in the right V2 and V3 dermatomes after a midpontine infarction localised at an ipsilateral principal sensory trigeminal nucleus
  1. T Kamitani1,
  2. Y Kuroiwa2,
  3. M Hidaka3
  1. 1Department of Neurology, Yokohama Miyazaki Hospital of Neurosurgery, Yokohama, Japan
  2. 2Department of Neurology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  3. 3Department of Neurosurgery, Yokohama Miyazaki Hospital of Neurosurgery, Yokohama, Japan
  1. Correspondence to:
 Dr T Kamitani
 Department of Neurology, Yokohama Miyazaki Hospital of Neurosurgery, 218-9 Kariba-cho, Hodogaya-ku, Yokohama, 240-0025 Japan;

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Isolated cranial nerve palsies are often attributed to lesions of the respective nerves along their extraaxial courses. However, ischaemic or haemorrhagic lesions of the brainstem also cause isolated cranial nerve palsies through involvement of the intraaxial segments of the respective nerves. Small lesions of the brainstem can affect the trigeminal nerve only, although isolated trigeminal nerve palsy occurs less frequently than third or sixth nerve palsy.1 A case of small medullary infarction was reported in this journal, involving the spinal trigeminal tract and nucleus and presenting as painful trigeminal sensory neuropathy. In this report, the patient presented with orofacial pain and abnormal sensation both of which were confined within ipsilateral maxillary (V2) and mandibular (V3) nerve distribution.2 A similar isolated sensory distribution in the V2 and V3 dermatomes was observed in our patient with a small dorsolateral midpontine infarction involving a principal sensory trigeminal nucleus. Our case was unique because light touch sensory deficit was restricted to the V2 and V3 dermatomes while the V1 dermatome remained intact. In a small number of previous reports, dorsolateral or entry zone infarction or bleeding at the midpons presented as isolated trigeminal nerve neuropathy which involved all trigeminal dermatomes, although some cases tended to show lesser involvement of the V1 dermatome and more marked involvement of the V2 and V3 areas.

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