Neurotrophic trigeminal syndrome after pontine stroke

The present study describes a patient, aged 72 yrs, with pontine crossed syndrome, displaying ipsilateral to the lesion a syndrome of cranial nerves V, VI, VII, VIII, on the right; a right neocerebellar syndrome; anhidrosis in the right hemibody; contralateral to the lesion: thermoalgic anesthesia with hyperhidrosis in the left hemibody. Concomitant with the pontine lesion, the patient developed torpid trophic ulcerations all over the right hemiface which, in the course of one year, became deformed, retractile, depigmented of hyperpigmented scars, the erosion being so deep at the level of the right nasal wing that the latter disappeared. This clinical picture developed in a patient with basilar invagination of 3 mm and left humeral micromelia. Eight cases of trigeminal torpid trophic ulceration associated with lesions of the brain stem are known till now, but association with vascular pontine lesion has not been described as yet. Etiopathogenic considerations are made.