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Epidermoid cyst presenting as isolated trigeminal neuralgia - two case reports
Ling-Chien Hung1, Chi-Shun Wu, Chou-Ching Lin
1Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan.
Acta Neurologica Taiwanica
|September 14, 2013
Summary
Symptomatic trigeminal neuralgia (TN) can be an early sign of cerebellopontine angle epidermoid cysts. Early neuroimaging is crucial for atypical TN presentations to ensure accurate diagnosis and treatment.
Area of Science:
- Neurosurgery
- Neurology
- Diagnostic Imaging
Background:
- Symptomatic trigeminal neuralgia (TN) constitutes up to 15% of all TN cases.
- Differentiating symptomatic TN from classic TN can be challenging despite established red flag signs.
Observation:
- Two cases of isolated TN with normal neurological exams are presented.
- Case 1: A 17-year-old female with right mandibular pain, abnormal blink reflex, and a cerebellopontine angle (CPA) tumor.
- Case 2: A 48-year-old female with chronic left V3 pain and a CPA cystic lesion.
Findings:
- Both patients were diagnosed with epidermoid cysts via tissue analysis.
- Postoperative pain relief was achieved in both cases.
- Case 1 showed a brainstem lesion and compression; Case 2 experienced cranial nerve palsies and Horner syndrome post-surgery.
Implications:
- TN can be the sole initial symptom of CPA epidermoid cysts.
- Physicians should consider neuroimaging for TN patients with atypical presentations.
- Increased vigilance for symptomatic TN is recommended due to its prevalence.
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